Application for NMCLC Membership

I am applying as a representative of one of the following:^*

National Organization
Regional Organization
Individual Faith Leader
Individual

Name of Organization:^*

Representative / Contact:^*

Address

Address Line 1 ^*

Address Line 2

City ^*

State or Region ^*

Zip ^*

Telephone^*

Office

Fax

Email^*

Letter of Appointment^*

Enclosed
To Follow

Letter of Appointment Upload

Membership Information

Active Member

a. Representative of National Christian / Muslim organization,
appointed, in writing by the organization.
b. Representative of a Regional organization, appointed, in writing
by the organization.
c. Individual Faith leader (non-voting)
d. Individual (non-voting)

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