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Affiliate Contact and Information Form

Affiliates please return this form within ten (10) days of your officer elections or if you have updates throughout the year. The contact information provided on this Affiliate Contact and Information Form will be used to update National Wildlife Federation's affiliate contact database and list serves, and it will be printed in the affiliate roster which is made available to NWF staff, board and affiliates.  Not all fields are required; please make sure to fill in any information that has recently changed to ensure our records stay updated.  Click here to view an affiliate roster and make sure our records are currently accurate before completing the form below.

Affiliate Name
Date of Officer Elections (mo/day/year)
Affiliate Mailing Address
Affiliate Shipping Address (for UPS or FedEx delivery)
Phone number
Fax
Web address
Email
Volunteer President / Chair Name

Is the title volunteer president?
  Yes       No

Is the title volunteer chair?
  Yes       No
Term starts (mo/year)
Mailing Address
Shipping Address (UPS or FedEx delivery)
Work phone
Fax
Home phone
Email
NWF Representative Name
Term starts (mo/year)
Mailing Address
Shipping Address (UPS or FedEx delivery)
Work phone
Fax
Home phone
Email
Sits on Affiliate Executive Committee?
  Yes       No
NWF Alternate Representative Name
Term starts (mo/year)
Mailing Address

Shipping Address (UPS or FedEx delivery)
Work phone
Fax
Home phone
Email
Treasurer Name
Term starts (mo/year)

Mailing Address
Shipping Address (UPS or FedEx delivery)
Work phone
Fax

Home phone

Email
Executive Director (paid) Name
Mailing Address
Shipping Address (UPS or FedEx delivery)
Work phone
Fax
Home phone

Email

Education Programs Contact Name
Term starts (mo/year)
Mailing Address
Shipping Address (UPS or FedEx delivery)
Work phone
Fax
Home phone
Email
Editor Name
Term starts (mo/year)

Mailing Address
Shipping Address (UPS or FedEx delivery)
Zipcode
Work phone
Fax
Home phone
Email

By submitting this form, you verify that the information you are providing is accurate and complete to the best of your knowledge.

Name:

Title
Date
Phone
Email