Participant Application Form

Membership Application

SHORTERLIFE.XYZ

Individual membership (Monthly fee: $10.00)

Name*

Email address*

Street address

Street address line 2

City

State

Zip code

Phone number*

Notes about individual membership privileges:
Our members get discounts on all programs and networking events. Membership includes a profile page where you can upload your logo, link to your site, and share your upcoming events and latest news.

Business & Payments member Details

Business/Organization name

Website*

Primary contact name

Primary contact email

Position

Street address

Street address line 2

City

State

Zip code

Paytm number*

Additional colleagues covered by membership (list up to three)

Work Start Date*

Date

Notes about group membership privileges:
Corporate members are allotted up to four free invitations to all programs and networking events, plus a company profile page to expand your reach within our community.

Duration of membership

From (date of membership approval) to (date of membership renewal). Club memberships are renewed annually.

Adhar Card*

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