Leadership (Individual) Membership

Membership Application

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

This membership application is for an individual professional applying for membership as a member. Estimated 10 minutes for finished this application. Please, submit all required fields before application will submit successfully.
Name (Primary) *

First Name Last Name
Birthday (Primary) *

Month Day Year
Date
Email address (Primary) *
example@example.com
Phone Number *
Please enter a valid phone number.
Professional Industry (Primary) *
Select One Industry
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
T-Shirt
Select Size
Leadership membership
Work Status (Primary) *
Active Professional License with DBPR? *
Select Yes or No
Active Business Registered in Florida? *
Select Yes or No
Business/Company name (Primary)
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: $3,000.00)

Non-Refundable (Intiation Fee: $750)
Notes about individual membership privileges:
Our members get discounts on all programs and guaranteed entry into 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