BNG-Application2024

Last*

First*

MI

Street Address*

ApartmentUnit

City*

State*

ZIP Code*

Phone*

Email*

example@example.com

Category Applied for*

Are you willing and able to make the meetings on time and miss no more than 10 meetings a year?*

YesNo

Are you willing and able to bring referrals YES NO and/or visitors to the group?*

YesNo

If yes where

Do you belong to other networking group ?*

YesNo

If yes where

Business Category Information

Company*

Phone*

Position*

Website*

Is this your primary occupation? *

YesNo

Terms Initial Application Fee (Non-Refundable): $50.00 Annual Membership Fee (Non-Refundable): $200.00 Checks can be made payable to BNG - C/O James Hardy 112 N 4th Street, Souderton PA 18964 Weekly Breakfast Fee Approx: $12.00 - $25.00 ($12.00 min regardless) Acceptance and/or Renewal: Subject to BNG leadership team. Members must pass a minimum of 12 referrals a year, and miss no more than 10 meetings a year. Arbitration: All disputes arising out of or related to this Agreement or the member's participation in BuxMont Networking Group, LLC shall be resolved by binding arbitration in accordance with the laws of the state of Pennsylvania. The Arbitration shall be subject to the Rules of the American Arbitration Association. This clause encompasses any and all disputes involving Buxmont Networking Group, LLC and their officers, directors, employees, agents and representatives, as well as members, provided that the disputes pertain to membership or participation in BuxMont Networking Group, LLC Release and Waiver of Liability: / hereby, for myself, my heirs, administrators and assigns, release, remise and discharge BuxMont Networking Group, LLC, their officers, directors, employees, agents, and representatives from all claims, demands, actions and causes of action of any sort for any cause whatsoever arising out of or related to this Agreement and/or conduct related to membership or participation in BuxMont Networking Group, LLC. / certify that / do not have any disciplinary charges pending against my professional service / license / permit /or registration in this county, state, or jurisdiction and if during membership should said disciplinary charge be brought against my professional service / license / permit /or registration / will inform the BNG leadership team immediately. / agree to the Terms, and / understand that my application acceptance and/or renewal is subject to the approval of the BNG leadership team.

Signature*

Date*

Date