Affiliate Form (Subscription)

CLINIC appreciates your affiliation with our growing network of charitable immigration legal programs. Our network is the largest of its kind, providing services in 49 states and more than 400 cities Our work together in 2020 will be of great importance.

To begin, please review the following documents:

Subscriptions are a flat rate of $1500. It has already been selected for you.

If you are logged in, the email below will be your primary contact's email for the organization.

If you're not logged in, please fill in the primary contact's email address for your organization. This person is who received the email from CLINIC to complete 2020 affiliate dues.

If you need to change who your primary contact is or how your organization appears in our database, please let your Field Support Coordinator know ASAP. Do not fill out the form until it is updated.

Total Amount
Organization Information (Subscriber)
Please enter in your organization name AS IT APPEARS in the email sent to the primary contact. This ensures that the payment gets applied to the correct record.
Please make sure your email matches the email above. This is where you receipt/invoice will be sent to.
Your Contact Information
Payment Options
[x] I would like an invoice emailed to me.