Membership Application

Company or organization name: First Name: Last Name: Job Title: Email: Phone: Address: Address Line 2 City: State: Alabama Alaska Arizona Arkansas 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 American Samoa Federated States of Micronesia Guam Marshall Islands Northern Mariana Islands Palau Puerto Rico U.S. Minor Outlying Islands Virgin Islands Armed Forces Americas Armed Forces Europe, the Middle East, an Armed Forces Pacific Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Territory Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory Zip: - Zip Suffix Website: Desired membership level: C-PACE Provider (>$150MM annual volume) ($30,000) C-PACE Provider ($100MM-$149.9MM annual volume) ($24,000) C-PACE Provider ($50MM-$99.9MM annual volume) ($18,000) C-PACE Provider ($25MM-$49.9MM annual volume) ($15,000) C-PACE Provider (<$25MM annual volume) ($12,000) C-PACE Provider (<$25MM annual volume) ($6,000) - First-year membership discount Community Based Lender ($10MM-$25MM) ($8,000) Community Based Lender ($2.5MM-$9.9MM) ($5,000) Community Based Lender (<$2.5MM) ($3,000) Community Based Lender - First Year Discount ($2,500) R-PACE Provider ($100,000) C-PACE Administrator ($2,000) Leader Membership ($12,000) General Membership (For-profit company) ($2,000) General Membership (Non-profit and quasi-governmental) ($500) General Membership (Government, fees-waived) Company or organization size: <10 employees 10-25 employees 25-99 employees 100+ employees Please explain your organization's relation to PACE and how you see your fit in the PACE community How would your organization benefit from a PACENation membership? Captcha