New - Membership Form (Organizations)

Company/Organization: Title: Mailing Address: Physical Address: 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 Code: - Zip Suffix County: Company Phone: Email: First Name: Last Name: Contact Phone: Is your organization a NEW or RETURNING member of the Alliance? New Returning Which type of member would you like to be? What are your organization's hours of operation? What type of organization do you operate? FOOD PANTRY - Please provide the best contact NAME (if different than the name listed above): FOOD PANTRY - Please provide the best contact PHONE NUMBER (if different than the number listed above): FOOD PANTRY - Please provide the PHYSICAL ADDRESS of the pantry (if different than the address listed above): What food bank service area is your organization located in? What is the age range of the population you serve? What is the average number of individuals you serve per month? What is the primary ethnicity of the population you serve? What information does your organization require for individuals to receive food? Would you like SNAP Call Center flyers sent to your organization to distribute to individuals? Yes No Is someone at your organization currently trained to take SNAP Applications? Yes No Would you like more information about SNAP Application Training and Support? Yes No