Affiliate Membership Application

Please complete the fields located below. For additional information, please contact memberservices@cic.edu.

Affiliate Membership Application

LinkedIn

This field is for validation purposes and should be left unchanged.

General Organization Information

Organization(Required)

Address(Required)

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

Phone

Website(Required)

Is your organization classified as a nonprofit (501(c)3 IRS status)?(Required)

Yes

No

Other

President or CEO

Full Name(Required)

Title(Required)

Email(Required)

Phone

Person Completing This Form

Full Name(Required)

Title(Required)

Email(Required)

Phone

In what capacity does your organization serve independent colleges and universities?

Which CIC programs and services are of particular interest to your institution?

Additional Information

Link to Annual Report