Please read the ERG Membership Structure Information (Pages 3 and 4) before submitting this form.

Applicant Information

Organization/Agency Name: *

Primary Contact Name: *

Primary Contact Email Address *

Phone number *

Membership Level Selection

Please select the membership level that best aligns with your ERG's goals and structure. *

Level 1: LIT Endorsed ERG, Annual Dues: $1,500 ($250 for active LIT members)

Level 2: LIT Affiliated ERG, Annual Dues: $2,500 ($500 for active LIT members)

Form

Have you obtained endorsement from or affiliation with LIT? *

Yes

Submit a name, mission statement, bylaws, and strategic plan. *

Submit a yearly plan of activities, goals, objectives, and budget. *

Submit an end-of-year report. *

Submit evidence of organizational agency approval for ERG formation. *

Only Level 1: LIT Endorsed ERG. Submit proof of liability insurance covering ERG programming.

Agreements

Please review the following agreements and select all checkboxes to confirm your understanding to the responsibilities associated with the selected membership level. *

I agree to ensure compliance with all requirements, including state mandates and agency policies, and to submit required reports and dues on time.

I acknowledge that the ERG is responsible for annual dues, fundraising efforts, and financial management.

I confirm that the ERG will implement programming and meetings as required.

I confirm that the ERG will send representation to the annual Leadership Summit and participate in LIT ERG programming.