Membership Application

Organization Name:*

Organization Main Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Which type of organization are you?*

Company
Nonprofit (501(C) designation)
Federal, Local, Tribal or International Government
College, University or Research Institute

Does your organization have active contracts with US states or territories?*

Yes
No

Please provide your business rationale for membership in NASCIO.*

If approved as a corporate member of NASCIO, does your organization agree to abide by the Corporate Member Policy?*

View Corproate Member Policy & Code of Practice

Yes
No

Please tell us a little about yourself

Full Name*

First Last

Job Title*

Business Email - (must be a personal business email address)*

email address must match organization domain

Business Phone*

Membership Contact

The MEMBERSHIP CONTACT is the primary liaison with NASCIO staff, receiving official correspondence such as invoices and notification of special opportunities.

Will you serve as the Membership Contact?*

Yes
No

Who will be the Membership Contact?*

First Last

Job Title*

Business Email (membership contact, must be a personal business email address)*

email address must match organization domain

Business Phone*

Profile Contact

The PROFILE CONTACT is the person listed on your organization's public profile and has U.S.-wide responsibility for relationship management and business development in the state government channel for the company. This is the person attending conferences, meeting with state CIOs and their staff. For corporate members, this person would also serve as the company representative on NASCIO's Corporate Leadership Council. In addition, they are responsible for ensuring the company's adherence to the Corporate Member Policy

Will you serve as the Profile Contact?*

Yes
No

Who will be the Profile Contact?*

First Last

Business Title*

Business Email (profile contact, must be a personal business email address)*

email address must match organization domain

Business Phone*

Organization Public Profile

If accepted into membership, the following company information will be used in your public profile on the NASCIO website.

Organization Bio*

Organization Website*

Organization X URL*

https://x.com/company

Organization LinkedIn URL*

https://www.linkedin.com/company/company name

Organization YouTube URL

https://www.youtube.com/NAME

Organization Logo (EPS format required)*

*BLACK or COLOR LOGO ONLY

Accepted file types: eps, Max. file size: 100 MB.

Organization Logo (PNG format required)*

*BLACK or COLOR LOGO ONLY

Accepted file types: png, Max. file size: 100 MB.

Government Logo / Seal (EPS format required)*

*BLACK or COLOR LOGO ONLY

Accepted file types: eps, Max. file size: 100 MB.

Government Logo / Seal (PNG format required)*

*BLACK or COLOR LOGO ONLY

Accepted file types: png, Max. file size: 100 MB.

Business/Market Area - Please select UP TO THREE (3) options.*

SELECT UP TO THREE (Hold the CTRL key for multiple selections)

Thanks for your interest in joining NASCIO. We’d like to learn a little about you.

Before you start, here’s the info you’ll need to complete the application.

Please tell us a little about yourself

Membership Contact

Profile Contact

Organization Public Profile

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