Membership Registration Form

Member Information

Membership Options *

Membership Level *

Dues:

Dues: $600

Dues: $125

Dues: $75

Dues: $50

Dues: 1 Year Free

Primary Contact

The primary contact for an agency serves as the point of contact between LGC and that agency for the purposes of invoicing. Each agency is allowed up to 10 members. All members will receive communications from LGC as outlined in the Membership benefits.

Will the primary contact be an LGC member?

Yes

No

First Name *

Last Name *

Title *

Organization *

Population

County

Region

County *

Region *

Phone Number *

Email Address *

Street Address 1 *

Street Address 2

City *

State *

Zip *

Website (optional)

Facebook URL (optional)

Twitter Handle (optional)

Birthdate (optional)

Alternate Contact

Please include your staff / scheduler’s contact information if applicable so they can be copied on emails, event announcements and other opportunities.

Staff Contact First Name

Staff Contact Last Name

Staff Contact Email Address

Staff Contact Phone Number

Agency Members

Agencies are allowed up to 10 members.

First Member

1. First Name *

1. Last Name *

1. Title *

1. Email *

1. Phone *

Add second member?

Add a second member?

Second Member

2. First Name *

2. Last Name *

2. Title *

2. Email *

2. Phone *

Add third member?

Add a third member?

Third Member

3. First Name *

3. Last Name *

3. Title *

3. Email *

3. Phone *

Add fourth member?

Add a fourth member?

Fourth Member

4. First Name *

4. Last Name *

4. Title *

4. Email *

4. Phone *

Add fifth member?

Add a fifth member?

Fifth Member

5. First Name *

5. Last Name *

5. Title *

5. Email *

5. Phone *

Add sixth member?

Add a sixth member?

Sixth Member

6. First Name *

6. Last Name *

6. Title *

6. Email *

6. Phone *

Add seventh member?

Add a seventh member?

Seventh Member

7. First Name *

7. Last Name *

7. Title *

7. Email *

7. Phone *

Add eighth member?

Add an eighth member?

Eighth Member

8. First Name *

8. Last Name *

8. Title *

8. Email *

8. Phone *

Add ninth member?

Add a ninth member?

Ninth Member

9. First Name *

9. Last Name *

9. Title *

9. Email *

9. Phone *

Add tenth member?

Add a tenth member?

Tenth Member

10. First Name *

10. Last Name *

10. Title *

10. Email *

10. Phone *

Survey

In an effort to better serve our members, the Local Government Commission will send out a brief survey to each applicant listed above.

Focus Area / Assistance / Community Vision / Mentorship (All Except Agencies)

Focus Areas

What are your main focus areas? Check all that apply.

Other *

Assistance

What would you like assistance with as a member of the Local Government Commission?

Assistance Options *

Meeting and networking with other local leaders

Partnership/mentorship from another local leader on a specific topic

Information on grants and free technical assistance for local planning projects

Assistance in crafting and adopting specific policies

Assistance in designing a larger Healthy Communities agenda for my community

Implementation assistance for a new program or policy

Nothing at this time

Community Vision and Smart Growth Successes

In an effort to better meet the needs of our members we would like to gather some information regarding our members' vision for a great community and smart growth successes.

More information (optional)

Yes, I would like to provide more information.

In a few words, describe your vision for a great community. For example, you might discuss what a healthy, livable community means to you; how smart growth and equity strategies could strengthen your community; or simply why you are interested in smart growth.

Vision for a Great Community (optional)

700 character max

Please share any recent smart growth successes in your community (e.g., downtown revitalization, bicycle and pedestrian improvements, mixed use development project, a new farmers’ market, etc).

Recent Smart Growth Successes (optional)

700 character max

Mentorship

Would you like to be partnered with a fellow local leader for advice or mentorship on a particular topic?

Mentorship Options *

Yes, I would like support from an issue expert from within this network.

I have expertise and can offer assistance to another leader.

No thanks, not at this time.

What type of support are you looking for? *

What type of assistance can you offer? *

Local Government Commission Membership Pledge

The Local Government Commission is a nonpartisan group of local elected officials, city/county government staff and associated professionals who share a deep and abiding commitment for transforming our communities into better places to live.

We are committed to leadership in advancing policies and implementation that link sustainable, equitable development with economic growth.

From revitalizing our main streets and downtowns, to preserving open space and the character of our rural communities, we believe long-term economic success, socially equitable opportunities and environmental sustainability are created by building healthy, resource-efficient access to jobs, housing, food, open space, services and education for everyone.

We support investing in our existing communities and creating healthy, vibrant places where everyone can live, work and play; where seniors can safely age in place and where the needs of the underserved are addressed so that all residents can enjoy a high quality of life. Such communities are not only great places to live, they attract businesses and create jobs, thereby boosting economic growth and prosperity.

As an advocate for smart growth, I believe the smart growth principles outlined in the Ahwahnee Principles) work to achieve these outcomes and I accept the invitation to become a member of the Local Government Commission.

LGC Pledge Endorsement *

Yes, I endorse the Local Government Commission Membership pledge.

How will you be paying your membership dues? *

Pay Online

Pay by Mail (Check)

I have already paid

Method of Payment

Membership Code