Leadership ( Couple ) Membership

Membership Application

Leadership ( Couple ) Membership
Orlando Black Professionals
Leadership (Couple) membership

This membership application is for married couples applying for membership as a Primary member with a Spouse. Estimated 15 minutes for finished this application. Please, submit all required fields before application will submit successfully.
Name (Primary)*

First Name Last Name
Name Spouse*

First Name Last Name
Birthday (Primary)*

MonthDay Year
Date
Birthday (Spouse)*

MonthDay Year
Date
Email address (Primary)*
example@example.com
Email address (Spouse)
example@example.com
Phone Number (Primary)*
Please enter a valid phone number.
Phone Number (Spouse)
Please enter a valid phone number.
Anniversary (Optional)

MonthDay Year
Date (We would like to acknowledge your Anniversary)
Professional Industry (Primary)*
Select One Industry
Professional Industry (Spouse)*
Select One Industry
Address*

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
T-Shirt (Primary)*
Select Size
T-Shirt (Spouse)*
Select Size
Leadership membership
Work Status (Primary)*
Work Status (Spouse)*
Active Professional License with DBPR?*
Select Yes or No
Active Business Registered in Florida?*
Select Yes or No
Business/Company name (Primary)
Business/Company name (Spouse)
Title/Position (Spouse)
Title/ Position (Primary)
Speak in front of an Audience?*
Advice, Motivation or Business Promotions
Group Travel Updates*
Travels aren't included in Memberships
Volunteer Opportunities *
Select Yes or No
Leadership Couple Membership (Annual fee: $5,000.00)

Non-Refundable (Intiation Fee: $950)
Notes about Couple membership privileges:
Our members get discounts on all programs and guaranteed entry listed events. Optional: Limited Speaking Role at Select Events and/or Promotional Opportunities

* Movie Nights 2023

*Masquerade Gala & Social 2023

*OBP Community Expo 2023

*Spring BBQ & Network Social 2023
Duration of membership

From (date of membership approval) to (date of membership renewal). Club memberships are renewed annually.
Should be Empty:

Membership Application