Community Non-Profit Organization Registration Form 

PLEASE NOTE: Before we can approve your application, you need to submit a copy of your 501(c)3. Please fax it to 718.935.9470.

Organization Information
Organization Name:
Address 1:
Address 2:
City/State/Zip Code:
Telephone # 1:
Telephone # 2:
Fax #:
Web Site URL:
Community Board #:	123456789101112131415161718
My Organization is:	Non-Profit
Contact Person Information
Salutation:	Dr.Mr.Mrs.Ms.None
First Name:
Last Name:
Title:
Login Name and Password
Email Address:
	Your email address will be your login name.
Password:
Re-type Password:

BRIC Arts | Media | Brooklyn, 647 Fulton Street, Brooklyn, NY 11217, tel 718.855.7882   fax 718.802.9095