Supporter Application

Basic Information


Work/Employment Information 

Demographic Information

To be as inclusive as possible, we hope to collect data that will let us understand our members through a diversity, equity, and inclusion lens. The information you provide will help us tailor programming to you and allow us to see who we may be missing. 

Donation Designation

Please choose where you would like to send your 60% donation. If you would like your donation to support membership fees for others in-need, choose "Support Another Lifelong Learner". If you would like to support a nonprofit not listed here please contact  

*All nonprofit orgnaizations must be a 501(c)(3) and agree to participate by submitting a W9 form before being added

*Please keep a copy of your registration confirmation email for tax purposes