Membership Application

Organization Name:(Required)

Organization Main Address(Required)

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

What type of organization are you?(Required)

Company

Nonprofit (501(c) designation)

Federal, Local, Tribal or International Government

College, University or Research Institute

Does your organization have active contracts with US state or territories?(Required)

Yes

Please provide your business rationale for membership in NASCIO(Required)

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

View Corporate Member Policy & Code of Practice

Yes

Please tell us a little about yourself

Full Name(Required)

First Last

Job Title(Required)

Business Email – (must be a personal business email address)(Required)

email address must match organization domain

Business Phone(Required)

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?(Required)

Yes

Who will be the Membership Contact?(Required)

First Last

Job Title(Required)

Business Email – (must be a personal business email address)(Required)

email address must match organization domain

Business Phone(Required)

Profile Contact

The PROFILE CONTACT is the person listed on your organization’s public profile who has relationships with state CIOs 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?(Required)

Yes

Who will be the Profile Contact?(Required)

First Last

Job Title(Required)

Business Email – (must be a personal business email address)(Required)

email address must match organization domain

Business Phone(Required)

Organization Public Profile

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

Organization Bio in plain text (1500 character limit)(Required)

Organization Website URL (provide the full URL)(Required)

https://company web address

Organization X URL (provide the full URL)(Required)

https://x.com/company

Organization Linkedin URL (provide the full URL)(Required)

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

Organization YouTube URL (provide the full URL)(Required)

https://youtube.com/NAME

Organization Logo (Single logo in an EPS format required)(Required)

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

*BLACK or COLOR LOGO ONLY as we utilize a white background

Organization Logo (Single logo in a PNG format required)(Required)

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

*BLACK or COLOR LOGO ONLY as we utilize a white background

Government Logo / Seal (Single logo in an EPS format required)(Required)

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

*BLACK or COLOR LOGO ONLY, as we utilize a white background

Government Logo / Seal (Single logo in a PNG format required)(Required)

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

*BLACK or COLOR LOGO ONLY, as we utilize a white background

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

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

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