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Charter Membership Application
Note: items marked * are required
First Name*:
Last Name*:
Mailing Address*:
Employer*:
Contact Phone*:
E-mail*:
Age Range*:
under 25
25-35
35-45
45-60
over 60
What is the nature of your work*?
What volunteer activities are you involved in*?
What aspects of leadership interest you*?
How did you find out about us*?
Referral
Internet
Advertising
Specifics:
What features of the web site attract you*?
What did you not find that you would like to know about*?
What did you not like about the website*?
Please indicate your choice: (note: maintenance fees will increase in future years)
One Year - $59.95
Two Years - $00.00
Three Years - $00.00
Note: Second and third year maintenance fees are waived for Charter Members.
Payment Preference:
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Your registration will be confimred by phone from an authorized Group Works representative.
Payment details to be arranged at that time.
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