BNCRC Membership Application
Please fill out the following form to be considered for membership. We will review your
applications and contact you as soon as we can.
*indicates a required field

Name of Organization*
The legal name that your organization operates under and commonly used acronym, if
applicable

Name of Contact*

Mailing Address*

Office Address
(If different than mailing address)

Telephone Number*

Email Address*

Website*

Other Social Media Platforms

Year Incorporated*

Non-Profit Status*
501(c)(3)501(c)(4)Other

Organization's Composition*
Membership-Based with Annual DuesSelf-Appointed

If Self-Appointed, is your Board Composed of:
ResidentsBusinessesOther

Number of Paid Staff*
This can include staff paid via another entity, part-time staff, interns, etc.

Number of Full-Time Staff*
Of these, indicate how many are full-time with benefits

Your Organization's Mission Statement*

Area and Population Served*
What is the geographic boundary and/or focus of your organization?

Problem Solving Approach*
How does your organization approach the problems facing the Buffalo-Niagara community?

Your Organization's Work*
How is your organization's work related to the BNCRC's mission? What are your
organization's goals related to advocating for responsible banking in the Buffalo-Niagara
region?

Your Organization's Business Purposes*
AdvocacyBusiness Attraction/Economic DevelopmentAcquiring Vacant PropertyHousing Development/Sustainable HousingCommunity SafetyClean and GreenBlight EliminationComplete Streets and Transit SystemsOther

Your Organization's Priorities*
What are your three most important organizational priorities?

Your Organization's Projects and Initiatives*
Describe up to three of your most relevant and current projects or initiatives. Please
only include work within Western New York.

Your Organization's Board Members*
Please provide your board roster, including all contact information for each individual
(name, address, phone, email) and indicate the officers. If applicable, include the
Executive Director of your organization.

Does your organization have existing philanthropic and/or business relationships with
financial institutions?*
YesNo

If relationships exist with financial institutions, would you be willing to commit to
campaigns in solidarity with the BNCRC to advocate for improved community reinvestment by
the institution?
YesNo

Is your organization willing to make a commitment to membership in the BNCRC, should you
be inducted as a member? Such a commitment may include, but is not limited to, attendance
at all meetings, prompt responses - both by phone and by email - to various requests
regarding Coalition activity, and adherence to all Coalition bylaws. Your organization
must be willing to commit two Coalition representatives that have both the ability and the
authority to speak on behalf of your organization and vote on your organization's position
regarding Coalition matters.*
YesNo

Proposed Member Delegates*
As indicated above, your membership to the BNCRC includes two representatives who are
authorized to speak and vote on behalf of your organization. Please identify the two
board-authorized proposed representatives and their contact information. Also, please
denote who will serve as the primary delegate/main contact.

Please include any additional information about your organization that you would like to
provide in the space below.