Please note: whether you are answering this on your own, or on behalf of your program team, we will only issue a single invoice for your institution.
First Name *
Your answer
Last Name *
Your answer
Why do you want to join the Nexel Collaborative? *
Your answer
Postsecondary Institution (e.g. university or college) affiliation *
Your answer
Your job title or role (and department, if applicable) *
Your answer
If you're filling this out on behalf of others on your team, and they would like to be included in our communications, please provide their name(s), title(s) and email address(es), with their permission.
Your answer
Do we have permission to list your school as a participant on TheNexel.org website? *
Location: complete physical mailing address *
Your answer
Telephone number (please include country and area code)
Your answer
Midlife transition program name and URL, if available
Your answer
Annual Dues are tiered, based on participant
program fees (actual or anticipated full cost to enroll in your program*). NOTE: Institutional membership includes access for all members of your team.
Institutional Tiers
Tier A. Under $5,000 US(or programs in development phase*).
Tier B. Between $5K and $19K.
Tier C. Between $20K and $49K
Tier D. Over $50,000 US per year
Individual Advocate: program alumni / ambassador
*Note for institutions: If your program is not yet ready to accept applications, but you have the support of your institution and are in development, please select Tier A. For those in the early stages of exploration- envisioning how to offer this kind of program and at your school (and awaiting 'buy-in' from the administration) - you may select the "Individual Advocate" category in order to take part in The Nexel's meetings and resources.
Please select the appropriate Membership Tier and Dues: *
Name and email address for Invoicing (if different from contact name above)
Your answer
Preferred payment method(s) for your annual dues:
After submission, we will contact you to confirm the appropriate tier, and other details for invoicing and inclusion in the Member Directory.
Please note: we will not be sharing this information with anyone outside the Nexel community.
Any comments or questions?
Your answer
Is there anything else you'd like us to know?
Your answer
A copy of your responses will be emailed to the address you provided.