GROUNDWORK NRG MEMBERSHIP FORM Thank you for your interest in becoming a member of Groundwork NRG. With your membership, you support our programming and projects in Northeast Kansas City, KS. Member Name * First Name Last Name Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Contact Person If different from Member's Name First Name Last Name Email * Areas of Interest * Please select from the following areas of interest. Environment Youth Programming Infrastructure Food Access Active Living Levels of Membership □ Individual □ Neighborhood/Community Group (regardless of tax-exempt status) □ Non-profits/Faith-based □ Business – Tier 1 (less than 10 employees) □ Business – Tier 2 (10-25 employees) □ Business – Tier 3 (more than 25 employees) Membership Level * Please select your membership level. See above for membership criteria. Individual - $10.00 Neighborhood/Community Group - $25.00 Non-profits/Faith-based - $50.00 Business - Tier 1 - $50.00 Business - Tier 2 - $125.00 Business - Tier 3 - $150.00 Thank you for submitting a membership application. We will be in touch shortly to review your application and payment method.
