CSUSA Membership Renewal Form – Crime Stoppers USA 1-800-222-TIPS

IMPORTANT PLEASE READ:

We have limited the required fields in this form. If you wish please go to www.crimestoppersusa.com, log in in the upper right corner and enter your information directly in the database for you program. If you do not have your programs login user ID and password, please contact us at 4info@crimestoppersusa.com and we will email you one.

Please update your statistics! There are two new categories which CSUSA needs your input, Homicide and Human Trafficking. These can be entered here or directly in the database.

Pricing as follows:

A - 0- 24,999- $110

B - 25,000-49,999 $165

C - 50,000 - 99,999 -$220

D - 100,000 - 249,000- $275

E - 250,000 - 999,999 $360

F- 1 Million + $375

G - State Association- $200 (Membership entitles only the state association)

H - Student Program- $50

I - Associates / Alumni- $75

J - Corporate - $300

501(c)3 and state nonprofit status valid and current?

Yes

Program Name*

Federal Tax ID

Is physical address the same as mailing address?*

Yes

Address*

Street Address Street Address Line 2 City State / Province / Region Postal / Zip Code Country

Program Number

Population Served

TIPS Phone*

Admin Phone*

Fax

Progarm Email*

Mailing Address*

Street Address Street Address Line 2 City State / Province / Region Postal / Zip Code Country

Website URL*

Counties Served*

Inception Date of Program

Does your program have insurance?

Yes

Total Number of Board Members

Please update your contact information here or online at www.crimestoppersusa.com and login in the upper right hand corner of the website and enter the data directly into the database.

Executive Director*

First

Last

Phone*

Email*

Chair*

First

Last

Chair Phone*

Chair Email*

Law Enforcement Coordinator*

First

Last

Law Enforcement Coordinator Phone*

Law Enforcement Coordinator Email*

Law Enforcement Coordinator #2

First

Last

Law Enforcement Coordinator #2 Phone

Law Enforcement Coordinator #2 Email

Treasurer

First

Last

Treasurer Phone

Treasurer Email

Secretary

First

Last

Secretary Phone

Secretary Email

Board Member #1

First

Last

Board Member #1 Phone

Board Member #1 Email

Board Member #2 Name

First

Last

Board Member #2 Phone

Board Member #2 Email

Board Member #3 Name

First

Last

Board Member #3 Phone

Board Member #3 Email

Arrests Made	782,932
Cases Cleared	1,161,118
Drugs & Cash Property	$4,148,814,967