Quick and easy registration
If your organization is selected to participate, you will be issued a password to be used in combination with your email address to access the website
Name
Street Address
City
State
Zip
Email address
Are you at least 21 years old and have legal capacity to enter a contract?       yes
      no
(You must be of legal age, and under no legal incapacity in order to register on behalf of your organization)
Name of organization
(Only bona fide non-profit youth organizations will be considered for participation)
Organization Contact Information
(Please provide the official address for your organization as registered with the state taxing authority)
Organization Address Line 1
Organization Address Line 2
City
State
Zip
Phone
Organization Leadership
(Please provide a listing of the offices and names of officeholders in your organization (i.e., officers, directors, trustees))
Approximate Number of Children Regularly Involved in Your Organization’s Activities
State Tax ID#
(You must provide a valid and verifiable non-exempt organization state tax ID number in order to complete registration. Should your organization be chosen for participation, you will also be required to provide a hard copy of your organization’s state tax exempt certificate prior to being allowed to participate)
Position with the organization
(By registering, you affirm that you are an authorized representative for the organization with authority to contract on behalf of the organization)
I have read and accept the Partnership Agreement (as amended from time to time in NBA-E’s sole discretion)
(In order to complete registration, you must affirmatively accept the Partnership Agreement on behalf of yourself and your organization)