SEIA Affiliate Application Form

Thank you for your interest in becoming an official SEIA affiliate! In order to begin the process, please fill out the form below. If you have any questions regarding the application process, contact Dana Sleeper at dsleeper@seia.org.

First Name

Last Name

Email Address

Phone Number

Organization Name

Website URL

Please attach a copy of the organization’s articles of incorporation

Please attach a copy of the organization’s bylaws

Please attach a copy of the organization’s Certificate of Good Standing from the state of incorporation

Please attach a copy of the organization’s IRS determination letter showing the 501c6 tax status of the organization. If your organization is not currently a 501c6, please submit your IRS determination letter and we will discuss this at the next step in the affiliation process.

Please attach a copy of the organization’s contact information for officers

Please attach a copy of the organization’s list of paid employees

Please attach a copy of the organization’s list of board members of the chapter, including board positions

Please attach a copy of your dues structure

Do you have a Political Action Committee (PAC)?

YesNo

Please provide a list of your accomplishments, if applicable. If your organization does not have a list of recent accomplishments, please explain why (for example, your organization may have just formed).

Please attach any additional documents that you would like us to review (This may include regulatory submissions, press releases, etc.).