Membership Application Form

MEMBERSHIP APPLICATION FORM
Is this a renewal application?*

YesNo
Renewing member who have no lapse in application renew will be honored membership fees at time of initial enrollment.
Business Information
Business Name (If Applicable)
Business Name
Representative Information

(Not for individual members)
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Current Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Website
Instagram
Referred by
Membership Category
Please Choose One*

Individual Member - $350 / yearGold Member - $750 / YearPlatinum Member - $1,500 / YearTrustee Member – $3,500 / year
WhatsApp Group

Please provide the name(s) and phone number(s) to be added to the WhatsApp group
Member 1 - Name*

First NameLast Name
Member 1 - Phone Number*
Please enter a valid phone number.
Member 2- Name

First NameLast Name
Member 2 - Phone Number
Please enter a valid phone number.
Member 3 - Name

First NameLast Name
Member 3 - Phone Number
Please enter a valid phone number.
Member 4 - Name

First NameLast Name
Member 4 - Phone Number
Please enter a valid phone number.
Member 5 - Name

First NameLast Name
Member 5 - Phone Number
Please enter a valid phone number.
Member 6 - Name

First NameLast Name
Member 6 - Phone Number
Please enter a valid phone number.
Payment

Once your membership is approved, we will send you an invoice with payments instructions
Autorization*

I authorize the verification of the information provided on this formI understand a background check will be done prior to application approval.I understand I will receive a a copy of this application after submissionThe membership will automatically renew unless written cancelation notice is receivedI understand CFBACC has "Right of Refusal" on my application due to certain circumstances.
Please note that payment request will be sent to your email listed above after approval of application by CFBACC's board of director.
Signature of Applicant

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Additional Information
Should be Empty:

MEMBERSHIP APPLICATION FORM

Business Information

Representative Information

Membership Category

WhatsApp Group

Payment