WNB VIP 2022 Membership

AKLF WNB VIP Membership Application

To apply for membership please complete all questions.
Name*

First NameLast Name
Name of Entity you are representing; (business, organization, ministry, industry or self). List only 1*
Your Website
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Date of Birth*

MonthDayYear
Date
E-mail*
example@example.com
Cellular Number*

Area CodePhone Number
Is it ok for WNB to text/call your cell phone*

YesNo
Upload your professional headshot; if you do not have one at this time, please send via email ASAP to info@AKLegacyFoundation.org

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Who referred you to WNB?*
How can WNB support you?*
What skill set would you like to learn in 2022?*
How can you help add value to WNB?*
What one business or life skill topic could you teach about in 30 minutes or less? (optional)
If your employer/organization is sponsoring your membership, please list their name here.
Please select your payment choice below. Dues are eligible for business tax deductions & are non-refundable*
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$50 per month for 12 months$50.00
Can join anytime- option expires Dec. 31, 2022

Total $0.00
Membership committment is valid from Jan. 1, 2022- Dec. 31, 2022; Memberships are active once payments are received. By preceeding, you are stating that you understand, agree to the terms and conditions stated above. Any questions or concerns, contact AK Legacy Foundation:

AK Legacy Foundation

330 Oak Harbor Blvd, Suite B

SLidell, LA70458

phone: 985-307-4774

website: www.AKLegacyFoundation.org

email at: info@AKLegacyFoundation.org
Your Signature below validates your agreement to this form*

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Please click one of the PayPal options to complete payment and submit the form.
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AKLF WNB VIP Membership Application