Membership Application
First Name:
Last Name:
Title:
Business Catagory:
Business Name:
Business Address:
Suite #:
City:
State:
Zip:
Business Phone:
Home Phone:
Fax:
Email:
Website:
Please describe the nature of your listed business category:
What is your position with this business?
Do you have any special licensing or certification?
YES
NO
Length of time in this profession?
Length of time with this company?
The fees for membership are as follows:
A one time set up fee of $35.
Membership Fees are only $30 per quarter. (If you join mid quarter your dues are only for the months of the quarter still remaining.) Please bring a check with you to the next meeting.
By Submiting this form;
I agree to abide by the by-laws of the North Coast Business Network regarding attendance and procedures. I am also aware that only one person in each business category is permitted, and that my application is subject to approval by the existing group.
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