Membership Application

Please complete the below form to apply for a NAFCU Membership for your credit union. You may also download a print-friendly version of the application to mail to us at 3138 10th Street North, Arlington, VA 22201; Attn: Catherine Safady, Vice President of Membership and Sales. If you have any questions, please contact NAFCU's membership division at membership_division@nafcu.org or 800-336-4644. *Indicates required field.

General Information

*Official Credit Union Name:

*Charter Number:

*Address:

*City:

*State:  

*Zip Code:  

*Phone Number:  

How did you hear about this program?

   

 

Mail Code #: 

 

If other, please specify: 

Areas of Interest 

*To better serve you, please indicate which benefits are of most interest and value to your credit union:

   
If other, please specify: 

 

Field of Membership

Please indicate your credit union's primary and secondary field of membership.

Primary Field of Membership: 
Secondary Field of Membership:

 

Personnel

Chief Executive Officer (CEO)
*Prefix  
*First Name:
*Last Name:
Informal Name:
*Title:
*Phone Number:
*Email:
   
Person Responsible for Compliance
Prefix:  
First Name:
Last Name:
Informal Name:  
Title:
Phone Number:
Email:
Executive Assistant to the CEO
Prefix:  
First Name:
Last Name:
Informal Name:
Title:
Phone Number:
Email:
   
Person Responsible for Finance
Prefix:  
First Name:
Last Name:
Informal Name:
Title:
Phone Number:
Email:
Chief Elected Officer (Board Chair)
Prefix:  
First Name:
Last Name:
Informal Name:
Title:
Phone Number:
Email:
   
Person Responsible for Marketing
Prefix:  
First Name:
Last Name:
Informal Name:
Title:
Phone Number:
Email:
Supervisory Committee Chair
Prefix:  
First Name:
Last Name:
Informal Name:
Title:
Phone Number:
Email:
     
If there are additional staff or volunteers who would benefit from access to the NAFCU website and publications, please send a list with their names, titles, email addresses and phone numbers to msc@nafcu.org.

Application Completed By:

*First Name: *Last Name: 
*Title: *
Email: