membership application

Our network of businesses believes in the power of connection. When we support each other, we all prosper. That’s why our primary goal is to create a sense of community and connectedness across the country through our services. Being part of our community means others in this network have committed to helping and supporting each other.

The questions below will give us an opportunity to get to know you. Please complete the information. We invite you to join our community in making a difference. Our application process might be a little bit different but so are we.

Be sure to complete the application in one sitting to insure that all of your information is saved. We’d hate for you to lose your hard work.

PART ONE: BUSINESS INFORMATION

Company Name:

First Name:

Last Name:

Email:

Business Phone:

Mobile Phone:

Website:

Business Street Address:

Additional Address Info:

State / Province:

City:

Zip / Postal:

PART TWO: ABOUT YOUR BUSINESS

1. Please take a few minutes to provide information that gives us a greater sense of who you are and why you are interested in this business network.

2. Provide a brief description of your business, core values and why your clients choose you.

How did you hear about us? (select from the dropdown)

- If a member referred you, please enter their name, so we can thank them.

- If you heard about us from another source, please explain.

Are you a non-profit?

Yes No

Are you a young entrepreneur? (you must be under 30)

Yes No

If yes, please provide your birthdate.

Support

Part of being in this community means you are committed to supporting other members in areas you excel in. In answering the questions below it is our goal to assist you in finding another member that can support you in the area you might need the most help with. The level of support given is entirely up to individual members and their availability.

The area of my business I could use the most support in is: (select from the dropdown)

- If other, please explain.

I can support someone in this community in the following area: (select from the dropdown)

- If other, please explain.

PART THREE: BUSINESS REFERENCES

Reference One

Name

Phone

Reference Two

Name

Phone

Reference Three

Name

Phone