Steps to Membership:

Date of Application:

Individual:

Business:

Applicant’s Name:

Title:

Company Name:

Email:

Business Address:

City:

State:

Zip:

Phone:

Fax:

Cell:

Description of Primary Business Activity:

You are an Owner/Partner:

Employee:

# of years with business:

Sponsored by (1):

(2)

(Need 2 signatures of Connections Club Members)

Primary Reason(s) for interest in becoming a Connections

member:

Personal data:

Name of spouse:

Home address:

City:

State:

Zip:

Phone:

Fax:

Cell:

I have read the connections by-laws and understand that my application is subject to two thirds of the general membership.

(Signature)

(Print Name)