Membership Application

Type of Application *

New

Reinstatement

Transfer

Company Owned Membership *

Yes

Application Date *

First Name *

Last Name *

Company Name *

Cell Phone *

Company Phone *

Email *

Website

Address

Street Address

City

State

Country

Postal Code

Referring Member

Business Category *

Business Description *

Reference #1 *

Name
Business Name
Email
Phone

Reference #2 *

Name
Business Name
Email
Phone

By checking this box, I consent to receive transactional messages related to my account, orders, or services I have requested. These messages may include appointment reminders, order confirmations, and account notifications among others. Message frequency may vary. Message & Data rates may apply.Reply HELP for help or STOP to opt-out.

By checking this box, I consent to receive marketing and promotional messages, including special offers, discounts, new product updates among others. Message frequency may vary. Message & Data rates may apply. Reply HELP for help or STOP to opt-out.

By signing this application you agree that the above statements are true and accurate and agree to allow representatives of the 815 Networking Alliance to verify your application, perform a background check, and confer with your referrals. Once your application has been verified it will be sent to the Board of Directors for Final Approval. If accepted, you agree to follow the By-Laws of the organization, have regular attendance at weekly meetings, social mixers, and fundraising efforts of the organization. You are also aware that upon acceptance to the Organization you will be required to pay a $25.00 one-time application fee that will be invoiced to you by the treasurer. *

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