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NEW MEMBER APPLICATION FORM

  MEMBERSHIPS LENGTH MEMBERSHIP TYPES & BENEFITS AMOUNT
     BENEFACTOR:
$2,500 or more 
Lifetime BENEFACTOR members receive all benefits listed below, special recognition, several books, past issues of Transition, The Journal of Men's Perspectives, and introducory materials.  If you provide an 8x10 signed photography or yourself, it will be framed and displayed in our offices.     
PROTECTOR:
$1,000 to $2,500 
Lifetime PROTECTOR members receive all benefits listed below, special recognition, a framed letter of appreciation, and a copy of at lease one book written by one of our NCFM members. Your name will be engraved and displayed on a plaque in our national office.     
GUARDIAN:
$500 to $1,000 
Twelve Years GUARDIAN members receive all benefits listed below, a letter of appreciation, and a bonus gift.     
GATEKEEPER:
$150 to $500 
Five Years GATEKEEPER members receive all the benefits below and a letter of appreciation.     
SUSTAINING:
$50 to $150 
Two Years SUSTAINING members receive "Other Benefits" shown below.     
SUPPORTING:
$35 
One Year SUPPORTING members receive "Other Benefits" shown below. $35 
STUDENT:
$10 
One Year STUDENT members can read back issues of Transitions online and access NCFM's Student Yahoo Discussion Group. $10 
"Other Benefits" means: New members should receive a welcome package if we have your correct mailing address.  All members may conditionally join and participate in our general membership online discussion groups, participate in certain NCFM events, attend our Face-to-Face national board meetings, join one or more NCFM chapters [additional chapter dues may be required], and access back issues of Transitions, The Journal of Men's Perspectives.
PLEASE VERIFY YOUR NATIONAL COALITION FOR MEN CHAPTER (DUES ARE SEPARATE): 
NCFM CHAPTERS:

I do not wish to join a
Chapter at this time.
Arizona$20
Los Angeles$10
Montana$10
NCFM Carolinas$10
New York$20
San Diego$20
Tennessee/Kentucky$20
Twin Cities (MN)$10
Please accept my membership selection(s) above and the following additional donation:  $   
PLEASE VERIFY YOUR PERSONAL CONTACT INFORMATION BELOW:
Please keep my membership confidential.  I understand my name will not be made public regardless of membership level as above.
CONTACT INFORMATION:
(*Required Information)
*First Name:  
*Last Name: 
*Mailing Address: 
 
*City: 
*State:  
*Zip:  
*Country:  
Home Phone:  
Work Phone: 
Mobile Phone: 
FAX Number: 
Occupation: 
*Contact Me By:
Email
Standard Mail*
Do Not Contact
*If you don't provide your current mailing address, we cannon send yhou your welcome package or membership gifts.
PLEASE MAKE ANY COMMENTS, SUGGESTIONS, OR REASONS FOR JOINING, RENEWING, OR DONATING BELOW:
PLEASE ENTER YOUR EMAIL AND A PASSWORD TO CREATE YOUR ONLINE NCFM MEMBERSHIP ACCOUNT**
ACCOUNT INFORMATION:
(*Required Information)

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login into your online account.

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at least 6 characters.
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