Teamworx Application

Name

Occupation

Company Name

Mobile Phone

Office Number

Mailing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Professional Classification in Group Requested

What other networking groups/social organizations are you currently a member?

What is your experience (in qualification and length) in this profession?

Are you willing to make a commitment to attend meetings regularly?

Yes

Are you willing to be an active member of the group? Not only committing to refer other members, but committing to the success of the group as a whole by participating in voting, member events, and referring members?

Yes

What three professions do you usually get the most of your referral business from and how can we help you have more facetime in front of these professions?

Membership Fee: $100/year Quarterly dues: $60 Membership Fee Waived each year if all Quarterly dues total of $240 is paid by January of that year.

Your membership will be voted on by the members. By signing below, you agree.

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