National Council on Independent Living Member Application Form

- Memberships will be accepted throughout the year, but CIL & SILC dues must be paid in full 30 days prior to the commencement of NCIL's Annual Conference to ensure voting privileges. 
- Upon payment of appropriate dues, it shall be assumed that a member unreservedly and sincerely supports NCIL's mission, vision, and guiding principles; copies of which shall be sent to all members annually.
- NCIL Memberships last one year from the date of transaction.
- Please note that, except in the instances of administrative error, NCIL memberships are non-refundable and non-transferable.
- Please return completed applications along with membership dues to: NCIL / PO Box 31260 / Washington, DC 20030 or 202.207.0341 (Fax) or denise@ncil.org. 
- If paying by credit card, consider mailing or faxing this form; email does not provide encrypted delivery of your personal information. Please make checks payable to National Council on Independent Living (Federal Tax ID: 74-2291620).

Membership Type 

You may use this form to join as an organization and an individual if the contact information is the same.

[ ] Individual: $35
[ ] Youth (26 and under): $10 
[ ] CIL
[ ] SILC
[ ] Other Organization

Please select:

[ ] New Member
[ ] Renewing Member

Contact Information

Prefix: 
Name: 
Organization (if applicable): 
Title (if applicable): 
I prefer to receive NCIL information at my:

[ ] Home
[ ] Business 
[ ] The rest of my contact information remains the same (skip to payment information) 

Email: 
Address: 
Apt / Suite #: 
City: 
State: 
Zip Code: 
Region (if known): 
Phone: 
Fax: 
TTY: 
Website: 

- For CILs, SILCs, & Organizations: Your Net Annual Operating Budget (minus pass-through funds): 

- CIL / SILC / Organizational Dues: 

- Individual Dues: 

- Additional Donation: 

Please charge my:

[ ] Visa 
[ ] MasterCard
[ ] American Express
[ ] Discover
[ ] I'm sending a check

Total amount: 
Name on Card: 
Expiration: CID / CIV: 
Card #: 

Organizational Dues Chart

NCIL Organizational Dues Chart: For Centers for Independent Living, Statewide Independent Living Councils, and other organizations

Operating Budget (minus pass-through funds) = Dues 

- Less than $100,000 = $150 
- $100,000 - $200,000 = $300 
- $200,000 - $300,000 = $450 
- $300,000 - $400,000 = $600 
- $400,000 - $500,000 = $750 
- $500,000 - $600,000 = $900 
- $600,000 - $700,000 = $1,050 
- $700,000 - $800,000 = $1,200 
- $800,000 - $900,000 = $1,350 
- $900,000 - $1 Million = $1,650 
- $1 Million - $3 Million = $1,950 
- $3 Million - $5 Million = $2,250 
- $5 Million - $8 Million = $2,625 
- $8 Million - $11 Million = $3,675 
- $11Million - $15 Million = $5,250 
- More than $15 Million = $7,875