National Association for Children of Alcoholics
AFFILIATE APPLICATION
NAME OF AFFILIATE ___________________________________________________
INCORPORATED NAME _________________________________________________
(IF DIFFERENT)
ADDRESS ___________________________________________________________
___________________________________________________________________
PHONE________________________________ FAX __________________________
E-Mail_________________________________Web__________________________
CONTACT PERSON_____________________________________________________
HOW AFFILIATION WILL STRENGTHEN YOUR ORGANIZATION'S MISSION: ___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
Please include the following with your application:
- Articles of Incorporation
- Evidence of 501(c) 3 IRS status or pending status
- Organization's mission statement and description of programs and services
- Annual Affiliate Fee of $250
Name______________________________________________________________
Title_______________________________________________________________
Signature______________________________Date_________________________
10920 Connecticut Avenue, Suite 100 Kensington, MD 20895
1-888-55-4COAS(2627) FAX (301)468-0987
www.nacoa.org