Application for Membership (draft)

Email(Required)

Phone Number(Required)

Individual Membership

The Bayh-Dole Coalition is a 501(c)4 organization. Therefore, financial contributions are not tax deductible as a charitable contribution, but may be deductible as a business expense. Please consult your tax advisor or accountant.

Questions? Contact Executive Director Joseph P. Allen at joe@bayhdolecoalition.org

Contribution Tiers:
Bayh-Dole Member ($250 - $499)
Bayh-Dole Sponsor ($500 - $4,999)
Bayh-Dole Steward ($5,000 - $24,999)
Bayh-Dole Champion ($25,000 - $49,999)
Bayh-Dole Guardian ($50,000 - $200,000+)

Contribution Amount

Please Write here

What affiliation(s) would you like to be listed by your name?(Required)

Organization Membership

Organization Name(Required)

Please enter the information for your organization's best points of contact below:

Should any other points of contact at your organization receive Coalition updates? If so, please add their information below:

POC First Name 1

POC Last Name 1

POC Email 1

POC Phone Number 1

POC First Name 2

POC Last Name 2

POC Email 2

POC Phone Number 2

POC First Name 3

POC Last Name 3

POC Email 3

POC Phone Number 3

POC First Name 4

POC Last Name 4

POC Email 4

POC Phone Number 4

Please upload your organization's logo for our Members page.(Required)

Max. file size: 20 MB.

Contribution

The Bayh-Dole Coalition is a 501(c)4 organization. Therefore, financial contributions are not tax deductible as a charitable contribution, but may be deductible as a business expense. Please consult your tax advisor or accountant.

Questions? Contact Executive Director Joseph P. Allen at joe@bayhdolecoalition.org

Contribution Tiers:
Bayh-Dole Member ($250 - $499)
Bayh-Dole Sponsor ($500 - $4,999)
Bayh-Dole Steward ($5,000 - $24,999)
Bayh-Dole Champion ($25,000 - $49,999)
Bayh-Dole Guardian ($50,000 - $200,000+)

Contribution Amount

Bayh-Dole Member ($250 - $499)

Bayh-Dole Sponsor ($500 - $4,999)

Bayh-Dole Steward ($5,000 - $24,999)

Bayh-Dole Champion ($25,000 - $49,999)

Bayh-Dole Guardian ($50,000 - $200,000+)

Hidden

Donation Amount

Hidden

Contribution Tier

Total

Credit Card(Required)

Card Details

Cardholder Name

Bayh-Dole Coalition Application for Membership (March 2023)

Individual Membership

Organization Membership

Contribution