MEMBERSHIP APPLICATION

DATE: _________________

Name of Applicant: _______________________________

Name of Business: _______________________________     Phone Number ________

Joining CBG as:      [  ] Individual            [   ] Business       E-Mail _____________________

Business Category Desired _______________________________________________

                                                            (must chose only ONE available category)

Business Address:  _______________________________

                                    (must be street address, no PO Boxes)

                                    _______________________________

What can you do for CBG?     ________________________________________________

                                                ________________________________________________

                                                ________________________________________________

Are you now in another business/networking organization?  [   ] Yes      [   ]   No

(excludes BBB and/or Chamber of Commerce)

Local References:     1. Name: ______________________________________________

                                        Address: ___________________________________________

                                        Phone: ____________________________________________

                                    2. Name: _____________________________________________

                                        Address: ___________________________________________

                                        Phone: ____________________________________________

                                    3. Name: _____________________________________________

                                        Address: ___________________________________________

                                        Phone: ____________________________________________

________________________________                        ________________________________

(Signature)                                                                 (Print Name)

________________________________                        Yearly Dues $80 [   ] Check [   ] Cash

Membership Approved (non refundable 3 days after acceptance) [   ] YES   [   ] NO