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 AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming 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 donationTwo bi-annual donationsMonthly donation Select from the following options for your membership donation. One time donationTwo bi-annual donationsMonthly donation Select from the following options for your membership donation. One time donationMonthly 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: * YesNo 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