Membership Application

* Mandatory fields

To fill out offline: Download Application HERE

Full Name:

Nickname:

Home Address:

Home Phone:

Cell Phone:

Email:

Birth date:

Spouse's Name:

Anniversary:

Names of Children:

Education:

Your interests & Hobbies:

Community Activities:

Business Name:

Industry:

Title:

Business Address:

Business Phone:

Business Email:

Business and/or Professional Organizations:

Will you be able to attend meetings regularly?*

Yes

Are you a former member? If yes, name of Club and City:

Dates of Membership:

Positions/ Activities in Club:

Annual Dues (Options) Please Choose One*

The club's fiscal year starts on October 1 of each year. The following lists the annual dues options:

Option 1: $968 (Includes dues and all meals)

Option 2: $560 (Includes dues and 20 meals)

Option 3: $200 (Covers dues only. Meeting meals are $20 each, paid at the meeting)

Annual dues are pro-rated for members who join during the fiscal year at $20 per month until the following October 1 under option #3 only. There is an additional one-time membership processing fee of $100.

Sponsor - Print Name:

Phone:

Reference #1:*

Relationship:*

Phone:*

Reference #2:

Relationship:

Phone:

Reference #3:

Relationship:

Phone:

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MEMBERSHIP APPLICATION

To fill out offline: Download Application HERE

Become a member today!

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