If you would like to become a member Agency. Fill out the entire form below and our staff will contact you directly, with the status of your membership.

Contact Information

		All fields marked with an asterisk (*) are required.
		Agency Name*
		Agency Federal ID # *
		Date of Incorporation*	(Example: January 1, 1992 or 1/1/92)
		Mailing Address*
		City*
		State*	Please Select State Alabama Alaska Alberta Arizona Arkansas Armed Forces Armed Forces Americas Armed Forces Pacific British Columbia California Colorado Connecticut Delaware Fed States of Micronesia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland North Carolina North Dakota Northwest Territories Nova Scotia Ohio Oklahoma Ontario Oregon Palau Pennsylvania Prince Edward Island Puerto Rico Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington Washington D. C. West Virginia Wisconsin Wyoming Yukon Other
		Zip*
		Phone #*
		Fax
		Email*
		Website Address
		Contact First Name*
		Contact Last Name*
		Title*

Please check all membership requirements met by your Agency. Please note: Member Agencies must comply with all eight (8) BABUF Membership Requirements to become and retain full membership.

Membership Requirements

		Req. 1*	The agency is directed by an active and responsible governing board.
		Req. 2*	The agency employs a full-time, paid executive director empowered to administer the agency and sufficient staff to provide services in accordance with the agency's purpose.
		Req. 3*	The agency conducts an effective human service program that addresses a demonstrated need.
		Req. 4*	The agency provides direct human services to to Bay Area African Americans.
		Req. 5*	The agency must be located in, and provide direct services within one or more of the nine Bay Area counties.
		Req. 6*	The agency has a certified independent financial audit prepared annually by a Certified Public Accountant or licensed public accountant. : If you do not have an audit, you must have a current income tax form I-990
		Req. 7*	The agency is incorporated in to one of the nine Bay Area counties and is determined as a tax-exempt organization as described in Section 501(c)(3) of the Internal Revenue Code.
		Req. 8*	The Agency agrees to identify and provide a volunteer for up to 10 hours to BABUF during campaign season (August-December) for campaign engagements and general campaign coordination.
		By sending this form, I (name), verify that (organization) is in compliance with ALL requirements checked.

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