FACC-NY Membership Application

We invite you to experience the unique rewards of FACC membership. Select from five levels designed to satisfy a wide range of business objectives.

Your membership will be automatically renewed upon expiring, you may opt out at any time by emailing membership@faccnyc.org. You will receive a reminder 30 days prior to automatic renewal.

You are completing this form on behalf of someone else. Please enter their details.

New Membership

If you have a discount code, enter it here

Membership Levels *

EL - Elite (6 individuals - premium corporate)

CP – Corporate - $3,500 (Councillor benefits to 6 individuals)

CL - Councillor - $995 (1 individual - premium)

AC – Active - $650 (1 individual – standard) ***Note: AC is minimum level required for J-1 Visa Exchange Visitor Host Companies

AS – Associate - $450 (1 individual - executive in transition, nonprofit, academic, retired)

YE – Young Executive - $295 (1 individual - 10 years or less of professional exp.)

Total Amount

COMPANY INFORMATION

Company Name *

If joining as an Executive In Transition, please write your name here.

Main Email *

Street Address *

City *

Zip Code *

Country *

State *

Website *

Your company logo will be displayed in the membership directory

Upload logo

Please select one category and a business description (500 characters or less) for your member directory listing.

Category *

Category - Secondary (optional)

(500 characters or less)

Business description *

Where are your company's worldwide headquarters located?

Parent Nation

How many employees does your company have in the US? *

How many employees does your company have worldwide (US+world)? *

Reasons for joining FACC NY *

INVOICING

Should membership invoices be sent to a different person/department? Should a purchase order be requested?

Different contact for invoicing

Yes No

Please provide all necessary instructions

FOR CORPORATE-LEVEL MEMBERSHIPS ONLY

Name, title and contact information

Additional Member #1

Name, title and contact information

Additional Member #2

Name, title and contact information

Additional Member #3

Name, title and contact information

Additional Member #4

Name, title and contact information

Additional Member #5

By clicking Join, you confirm that you understand that your above personal data will be processed by FACCNY to register you as a new member, update our Members Directory, compile our CRM database, set-up your Member Dashboard and send you newsletters and news alerts and that you have read the FACCNY Privacy Policy which provides further details on the processing of your data and your rights.

Account

Please enter a Username to create an account. If you already have an account please login before completing this form.

Username *

Check Availability
Punctuation is not allowed in a Username with the exception of periods, hyphens and underscores.

Password

Confirm Password

Provide a password for the new account in both fields.

CONTACT INFORMATION

Prefix *

First Name *

Last Name *

Email *

Phone Number *

Mobile

Job Title *

Citizenship *

How did you hear about the FACC?

Upload your headshot

Your headshot will be displayed in the membership directory

Interested in hosting FACC event

Yes No

Event room capacity (# people)

Credit Card

Card Type

Card Number *

Security Code *

Expiration Date *

Billing Name and Address

Billing First Name *

Billing Middle Name

Billing Last Name *

Street Address *

City *

Country *

State/Province *

Postal Code *