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ABWN 2019 Membership Form
2019 Membership Request
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* Indicates required question
First Name
*
Your answer
Last Name
*
Your answer
Business Name
*
Your answer
Address
*
Your answer
City, State, Zip
*
Your answer
Phone
*
Your answer
Fax
*
Your answer
Email
*
Your answer
Website
*
Your answer
I agree to email my headshot ASAP for the Directory? (send to
info@wise-strategy.com
)
*
Yes
I need someone to take my headshot
Nature of Your Business
*
Your answer
Are you interested in sponsoring a luncheon for $50?
*
Yes
No
Membership Level
*
Individual Membership for $40.00
Corporate Membership for 3 people for $100.00
Additional Team Members for $30.00 each
Additional Business for $30.00 each
Required
Yearly Luncheon Package for $110.00
*
Yes
No
How many Yearly Luncheon Packages?
*
Your answer
Prepay for Door Prizes
*
6 Tickets each month for $55.00
12 Tickets each month for $110.00
No Thank You
Additional Contribution to Kim Tinkham Fund?
*
Your answer
Total Payment for August (At the Door)
*
Your answer
Additional Business Name (#2)
Your answer
Business Address (Street, City, State, Zip)
Your answer
Business Phone Number
Your answer
Business Email Address
Your answer
Business Website
Your answer
Additional Business Name (#3)
Your answer
Business Address (Street, City, State, Zip)
Your answer
Business Phone Number
Your answer
Business Email Address
Your answer
Business Website
Your answer
Additional Team Member Name (First Last)
Your answer
Team Member Phone Number
Your answer
Team Member Email Address
Your answer
Additional Team Member Name (First Last)
Your answer
Team Member Phone Number
Your answer
Team Member Email Address
Your answer
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