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Membership Application
Note: items marked * are required
First Name*:
Last Name*:
Address:
Employer:
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?
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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?
Would you like to be considered for Charter Membership?
Yes
No
Please indicate your choice: (note: maintenance fees will increase in future years)
One Year - $59.95
Two Years - $99.95
Three Years - $149.95
For the first 350 non-charter members first year fees are waived, so these periods are for two, three and four years.
How would you like to pay - please indicate your choice:
Cheque
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Upon receipt of your application an authorized representative of Group Works will contact you regarding payment details.
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