We Do Business

New Member Application Forms

L.E.A.D.$ .EXCHANGED ADD DOLLARS

Member Application

Click here for print-friendly documents: Application and Bio.

Please fill out this form completely. Submit the completed form, 30 business cards and a bio of yourself and your business to the Vice President/Membership Chairman or Secretary. Upon acceptance you will be required to pay dues in the amount of $ 90.00 per year (prorated according to time of year) no later than the second meeting thereafter. For more detailed information, refer to the bylaws you received with this application.

Date: _______________________

Last Name: _______________________

First Name: ________________________

Birth Mo/Day: _______________

Business Name: _________________________________________________

Business Address: _______________________________________________

City: ______________________________________________

ZIP: _____________

Business Phone: __________________________

Fax: _______________________

Cellular: _____________________________

Pager: _________________________

*Home Address: _________________________________________________

City: ______________________________________________

ZIP: _____________

Home Phone: _____________________________
*Confidential information, for Board use only

Description of Business:
________________________________________________

____________________________________________________________

_____________________________________________________________


Please attach three references of persons or businesses who have used your products or services.
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Do Not Write Below This Line - Board Use Only

Date Appl. out: ______________ Date submitted: ____________________

Board Meeting Date: ___________________

Bio? ________ Business Cards? __________ Ratified? _______________

Referred by: ____________________________________________________

Notes: __________________________________________________________

L.E.A.D.$

Business & Personal Bio Outline

Personal

Name: __________________________________________________

Family: ___________________________________ Age: __________

How long in area: _________________________________________

Education: _______________________________________________

Hobbies: _________________________________________________


Business

How long in business: ______________________________________

Primary business function: __________________________________

Secondary bus. functions: ___________________________________

________________________________________________________

Number of employees: _____________________________________

Area serviced: ____________________________________________