Membership Application – Boise Leaders Networking Group

Quarterly dues are $150.00. Quarterly dues statements for the next quarter are delivered at the last meeting of the previous quarter, with dues payable by the last meeting of January, April, July and October. For new members joining, partial quarter dues will be $45.00 per month. A $25.00 administrative fee is also due with submission of this application. Please make all checks payable to: The Boise Leaders Networking Group.

Name *

First

Last

Email *

Business Name *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Nature of Business *

Work Phone *

Home Phone *

Website *

Date of birth (month/day only) *

Business Reference #1 *

Business Reference #2 *

Business Reference #3 *

Membership Dues paid by: *

Company
Member

Leads Groups *

Recommendations: *

Billing Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone