| Name: |
|
| Date: |
|
| Business Name:
|
|
| Business Address:
|
|
| City: |
|
| State: |
|
| Zip: |
|
| Home Phone: |
|
| Work Phone: |
|
| Fax: |
|
| Email: |
|
| Website: |
|
Date
of Birth:
(Month/Day Only) |
|
Spouse's
Name:
(If Applicable) |
|
| Company Name:
|
|
| Nature of Business:
|
|
Please
list three business references
(Company name, contact
name, phone): |
| Business Reference
1: |
|
| Business Reference 2:
|
|
| Business Reference 3:
|
|
|
Membership Dues Paid By:
|
Member
|
|
|
Company
|
Are
you currently active
in any other leads or
networking
groups?
If yes, list groups: |
|
Is
there anyone you would like to recommend to join our
group?
|
|
Billing Address
|
|
Spam Prevention:
Please enter the
displayed number.
This helps to prevent Spam from
automated computers. |
|
Quarterly dues are $135.00. Quarterly dues statements
for the next quarter are delivered at the last meeting
of the previous quarter, with dues payable by the last
meeting of January, April, July and October. For new
members joining, partial quarter dues will be $45.00
per month. A $25.00 administrative fee is also due with
submission of this application. Please make all checks
payable to: The Boise Leaders Networking Group. |
|
|
|
