interest form Thank you so much for your interest in joining The Collective! Please fill out the interest form below. We look forward to hearing from you and will be in touch soon. Listed below are the specific membership benefits available based on your annual giving level. The Collective Membership Application Giving Levels Philanthropist ($1000+) Invitation to all Collective Events and exclusive Philanthropist only events The Collective Membership gift Free ticket to our annual Local Fare for Local Freedom Free monthly coffee drink Recognition in the annual report and on Collective Website Year End Gift Change Maker ($500+) Exclusive Invitation to all Collective Events (including professional mentorship seminars) The Collective Membership gift Discounted ticket to our annual Local Fare for Local Freedom Free monthly coffee drink Complimentary professional headshot session Young Professional ($150+) Exclusive Invitation to all Collective Events (including professional mentorship seminars) The Collective Membership gift Discounted ticket to our annual Local Fare for Local Freedom Free monthly coffee drink Discounted professional headshot session General Information First Name * Last Name * Birthday * Cell * Email * Mailing Address * Mailing Address Mailing Address Mailing Address City City State/Province Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State/Province Zip/Postal Zip/Postal Membership Membership Level * Philanthropist ($1000+) Change Maker ($500+) Young Professional ($150+) Donation Amount * Select from the following options for your membership donation. One time donation Two bi-annual donations Monthly donation Select from the following options for your membership donation. One time donation Two bi-annual donations Monthly donation Select from the following options for your membership donation. One time donation Monthly donation Communication Preferences I prefer to receive Collective information via: * Email Phone Call Text Facebook Group Slack OtherOther I am interested in holding a leadership role: * Yes No I am interested in serving on a planning committee for the following events: Get Fit and Fight Run for a Reason Local Fare for Local Freedom Giving Tree I'm not sure, I'd like to have a call with you to learn more. Not right now, thanks If you are human, leave this field blank. Submit Δ