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COMBINEDBrain Member Interest/Information Form 2024
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* Indicates required question
Organization/Foundation Name
*
Your answer
Website
*
Your answer
Primary Contact Name
*
Your answer
Title of Primary Contact (in Organization)
*
Your answer
Preferred Phone Number
*
Your answer
Mailing Address
*
Your answer
Email
*
Your answer
Will your organization host a family meeting this year?
*
Yes
No
Undecided
If hosting a family meeting, what are the dates/location?
*
Your answer
Annual Budget
*
Less than $25,000
Between $25,000 and $50,000
Between $50,000 and $100,000
Between $100,000 and $250,000
Between $250,000 and $500,000
Between $500,000 and $750,000
Between $750,000 and $1,000,000
Between $1,000,000 and $2,000,000
Between $2,000,001 and $5,000,000
Greater than $5,000,000
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