the Institute
Communication   Collaboration   Capacity Building
for Human Services Inc.

IHS Application Form

Member Organization Information

Contact Name: Title:
Organization:
Address:
City: State: Zip Code:
Phone: Ext.
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Membership Fees

Annual Agency Budget Annual MemberShip Fee
Under $50,000 $35
$50,001 - $250,000 $75
$250,001 - $1,000,000 $125
$1,000,001 - 5 Million $175
$5 Million and Over $225

Agency Contacts

Area Contact Name Telephone # E-mail
General Contact
Human Resources
Communications and Marketing
Education and Training
Technology Support
Website