Corporate Partners
About Us
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Benefits
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Corporate Partners
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Calendar of Events
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Board of Directors
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Ambassadors
Previous events
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Discounts
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Membership
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Spotlight
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Contact Us
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Member Directory
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Resources
Please Fill Out the Form below or
Click Here
to Download the Printable PDF form
Business Name
Address
City
State
Zip
Business Phone
Business Fax
Email Address
Website
Type of Business
HealthCare
Attorneys/Law Firm
Restaurant
Telecommunication
Financial Institute
Realtor / Mortagage Broker
Other (please specify)
Number of Employees
Name of Rep 1
Title
Ext.
Email
Name of Rep 2
Title
Ext.
Email
Could You Extend Discounts to Members?
Yes
No
Type of Discount
and How Much
Referred By
Membership Fees per year
Non-Profit Organization...............................................................................$100.00
Small Business / Professional (1 to 4 employees)...............................$150.00
Medium Business / Corporation (5 to 19 employees)...........................$300.00
Large Business / Corporation (20 or more employees).......................$500.00
Corporate Partners.......................................................................................$2000.00
Cardholder Name
Card Type
Visa
Master Card
Discover
American Express
Card Number
Expiration Date
Signature
(please type full name)
Date Signed
Please Call 954.961.6386 with any questions or fax the downloadable form to 954.961.8319
Click here to Download the
Membership Application &
Credit-Card Payment Form
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