Membership Application

Business/organization name: _____________________________________________________________ Primary contact: ____________________________________ Title: ______________________________ Business description: ____________________________________________________________________ Address: ______________________________________________________________________________ City: _____________________________________ State: ________________ Zip: _________________ Office Phone: _________________ Home Phone: ____________________ Mobile: __________________ E-mail: ___________________________________ Website: ___________________________________

Select membership level

Sustaining membership This premium membership plan includes eligibility to serve on the NCIA board of directors, access to exclusive industry events, high-profile listing in association materials, and all to the benefits of a Sponsoring Membership. Dues are $5,000 annually or $500 monthly. Regular membership This is a basic membership plan that includes national representation for your business, listing in association materials and eligibility for member discounts. Dues are $1,000 annually or $100 monthly. Sponsoring membership This preferred membership plan grants eligibility to vote in NCIA board elections and includes all to the benefits of a Regular Membership. Dues are $2,500 annually or $250 monthly. Make checks payable to: National Cannabis Industry Association P.O. Box 78062 Washington, DC 2001

NCIA statement of ethics: As a member of the National Cannabis Industry Association and to the best of my ability, I will ensure that my business practices are ethical, responsible, and consistent with the highest of community standards. I acknowledge that the cannabis industry is subject to unusual scrutiny by the general public, media, and policy makers and will conduct my business affairs as a representative of that industry accordingly. Signed: ______________________________________ Date: ___________________

The National Cannabis Industry Association is organized as a 501(c)(6) non-profit corporation. Membership dues are not deductible as charitable contributions, but the portion of dues not used for lobbying activities are deductible as trade or business expenses. At least 50 percent of membership dues will be used for non-lobbying purposes. For more information, contact NCIA at (202) 379-4861 or Info@TheCannabisIndustry.org