ORGANIZATIONAL MEMBERSHIP APPLICATION OR RENEWAL

In joining the Minnesota Women’s Consortium, the undersigned recognizes that the common purpose of the Minnesota Women’s
Consortium is to achieve full equality for women. The Consortium is an association of organizations and individuals committed
to feminist goals not in conflict with those set out in the Houston Plan of Action, U.N. Decade of Women 1977. While no organization
is likely to take a stand on all of these issues, the undersigned hereby agrees they will not actively work in opposition to any
of these planks. It is understood that the Consortium as an entity does not endorse specific legislation or individual candidates for
public office, but that member organizations may undertake these activities according to their own priorities.

Once an organizational membership application has been received, it must be reviewed by the Board of Directors and then ratified
by the voting delegates of the Minnesota Women’s Consortium. After ratification, an organization will become an official
member of the Consortium upon payment of dues and election/appointment of one Delegate and one Alternate. The Delegate or
Alternate will be the organization’s official representative and voting member of the Consortium.

Organizational member dues are listed below. Please set your own rate based on the membership size and annual financial capability
of your organization. Individual subscriptions to the CAPITOL BULLETIN are $50 annually.

$90 Budgets to $150,000
$120 Budgets $150,000-$300,000
$250 Budgets $300,000-$500,000
$450 Budgets $500,000 and over

Date

Organization

Official Address

Telephone

Website

Email

OFFICERS AND BOARD OF DIRECTORS

Name/Title

Name/Title

Name/Title

Name/Title

Our organization designates the two named individuals as our representatives to the Minnesota Women’s Consortium:

DELEGATE:

ALTERNATE:

The CAPITOL BULLETIN should be mailed to the 3 following designees:

1)

2)

3)

The Consortium provides diversity in all its activities. Providing the information below is optional, and we hope you will do so to help us assess our progress.
As an organizational member, we can be counted as representing the following groups:

____ Women of color ____ Immigrant women

____ Women under age 35 ____ Business women

____ Women of Greater Minnesota (excluding St. Paul, Minneapolis, and their suburbs)

____ Women in higher education (faculty, staff, and/or students)

____ Other special group often under-represented: ____________________________


INFORMATION FOR THE NEW CONSORTIUM DIRECTORY

Date

All information provided by your organization will be available to Consortium members and the general public. Please
complete the material relevant to your organization that you are willing to share.

ORGANIZATION NAME

ADDRESS

CITY, STATE, ZIP

PHONE

EMAIL

WEBSITE

Underline one: Chair Director President Other

Name

Address

Phone

Email

PRIMARY PURPOSE/GOAL:

SPEAKERS AVAILABLE:

Contact Name

Phone

Email

LEGISLATIVE CONCERNS: Please list briefly most important, in order of importance:

SERVICES PROVIDED FOR MEMBERS/CLIENTS: Please list briefly most important:

CHECK ONLY ONE CATEGORY BELOW FOR A QUICK-REFERENCE LISTING IN THE BACK OF THE DIRECTORY:

___ Advocacy Organization ___ Faith Based Organization
___ Arts and Literature Organization ___ Human or Direct Service Organization
___ Educational Organization ___ Health Issue Related Organization
___ Immigrant/Refugee Organization ___ Political or Quasi-Political Organization
___ Sports/Recreation Organization ___ Professional Association
___ Other Special Group often Under-represented