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Membership Application

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State: County: Business Name: Business Address: Mailing Address: Phone: Mobile Phone: Birth day: M/Y Website: Transferring from another County Yes / No County transferring from: (If yes, a transfer fee of $50.00 must be included with application) Business Category: Describe your business category and service: Does your business require licensing? Yes / No / Type of license and license number Certification? Yes / No Accreditation? Yes / No Is the business a: Corporation / Limited Liability Company / Sole Proprietor / Partnership / Other Your position is: Owner / Employee / Independent Contractor / Other Number of years in business? In the event you are unable to attend a meeting, who would your representative be? Who referred you to our group? Do you belong to any other networking organizations? / If yes, which one(s)? With your electronic signature below, you verify that you understand and agree to all terms of this application. Signature of applicant: / Date: Office use only: Date received: Web entry: Prospective Member Interview Conducted Yes / No Approved by Membership Council Yes / No / Date: Membership Council Signature: / Name: Badge: Welcome info Payments collected are non-refundable: New applicant: Application: Transfer fee: Annual Membership: Biennial Membership: We accept credit cards and PayPal

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Business Networking

Membership Application

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