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 NameLast Name
Birthday (Primary)*

MonthDayYear
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

CityState / 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