GPNP Membership RENEWAL Form

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I would like to update the following information:

Information about my Organization

Additional Staff Members at my Organization

Please choose all that apply.

Membership Information

Organization *

Subsector *

Dues are determined by your organization's annual operating budget. Please select the correct category.

Member Dues *

Less than $999K = $100 Dues

$1M-$4M = $200 Dues

$4M-$10M = $300 Dues

Over $10M = $500 Dues

Corporate/Consultant = $500 Dues

Automatic Annual Renewal *

If you choose to renew automatically your credit card will be charged your dues amount on this date next year.

Additional Donation

If you would like to add an additional donation to your member dues please enter it here.

Total to be charged today

This field is calculated automatically and should not be edited directly.

Read the following statement to agree to the terms. *

Update Primary Contact Information

Prefix

Prefix Other...

First Name *

Last Name *

Suffix

Suffix Other...

Title/Position

Address Line 1 *

Address Line 2

City *

State *

Postal Code *

Phone *

Email Address *

Update Additional Staff & Locations

You can add up to 5 additional staff members as GPNP member contacts. Would you like to add additional contacts to your membership? *

These individuals will also receive GPNP mailings, announcements, invitations, and other information.

Employee 1

1. First Name

Last Name

Email Address

Title

Employee 2

2. First Name

Last Name

Email Address

Title

Employee 3

3. First Name

Last Name

Email Address

Title

Employee 4

4. First Name

Last Name

Email Address

Title

Employee 5

5. First Name

Last Name

Email Address

Title

Do you have multiple locations? *

If so, how many?

The address entered in the primary contact section is considered the first location.

Location 2 Address

Address Line 1

Address Line 2

City

State

Postal Code

Location 3 Address

Address Line 1

Address Line 2

City

State

Postal Code

Location 4 Address

Address Line 1

Address Line 2

City

State

Postal Code

Location 5 Address

Address Line 1

Address Line 2

City

State

Postal Code

Location 6 Address

Address Line 1

Address Line 2

City

State

Postal Code

Location 7 Address

Address Line 1

Address Line 2

City

State

Postal Code

Location 8 Address

Address Line 1

Address Line 2

City

State

Postal Code

Location 9 Address

Address Line 1

Address Line 2

City

State

Postal Code

Location 10 Address

Address Line 1

Address Line 2

City

State

Postal Code

Billing Information

This address will be used to validate your credit card and must match your credit card billing address.

Is the billing information the same as the primary contact

Address Line 1 *

Address Line 2

City *

State *

Postal Code *

Country *

Membership is good for one year, from the date of your payment. Please make sure to renew your membership within 30 days of this date, or we will have to add a 10% surcharge for administrative costs.

For additional information, please contact:

Samantha Balbier, Executive Director
GPNP
c/o The Forbes Funds
Five PPG Place, Suite 250
Pittsburgh, PA 15222

Phone: 412-394-4275
Email: balbier@forbesfunds.org

Join Our Mailing Lists

From the options below, please select the mailing lists to which you would like to be added.

Mailing List Options

GPNP Committees

Please indicate if you'd like to participate in, or would like more information about, any of the following opportunities:

Committees

Public Policy Committee

Membership Committee

Networking/Social Events

Legislative Visits/Advocacy

Taxation Subcommittee

Please complete the fields below to submit payment.

Credit Card Information

Payment Type *

Credit Card

E-Check

Card Type

Cardholder Name

Credit Card Number

CVV Code

Expiration Month

Expiration Year