Your Contact Information

Contact First Name: *

Contact Last Name: *

CBA Id: (If Applicable)

Email Address: *

Best phone number to reach you at?

Please provide a minimum of 1 contact phone number *

Cell Phone Number:

Home Phone Number:     

Office Phone Number:

Your Favorite Charity is Not  a Member Yet, 
  Just fill out the short Referral form below about the Charity you would like to refer to participate in the program.

  The Community Partnership Program was created to help and improve the way your Charity raises funds to finance their missions and goals, and also to help their members receive savings on products and services.

Who Can Join?

Community & Faith
Based Organizations




Schools & Colleges

Youth Scouting, Extra Circular
Groups and Sporting Teams_

“Our Passion is to help your Community Group’s Cause”

The Community Group you refer today, enrolls at no cost!

Charity's information you would like to refer:

Please note that fields marked with an (*) are required.

Name of Charity you would like to refer: *

Charity’s person to contact: *

Contact person’s Phone Number: *

Charity's Phone Number: *

Charity's Email Address:

Charity's Address

Street Address 1:

Street Address 2:

City: *


Zip Code:


How did you hear about the Community Partnership Program?
Referred By Whom?
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"The Community Partnership Program is
designed to produce a "Sustainable" revenue stream for its
Community Partners, while providing savings to their members on
products & services"
Community Partnership Program
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The Community Partnership Program, LLC