New Member Application

Chapter *

First Name *

Last Name *

Phone Number *

email address *

Street Address 1 *

City *

State / Province *

Postal code *

Mailing Address

Company / Business Name *

Business Category *

Website

Does your profession require special licensing? *

Does your profession require special certifications? *

Does your profession require any special accreditations? *

If yes to any, please explain or describe here:

Brief description of your business: *

Position in relationship to business *

Years in business *

Is this your primary business? *

Membership will be funded by whom? *

Who referred you to TEAM? *

Name Badge - First & Last Name *

Name Badge - Business Name or Category *

I am transferring from another CHAPTER (already a member). *

New Membership Payment Options *

1 Year Membership $445.00 plus $50 enrollment = $495.00

2 Year Membership $710 plus $50 enrollment = $760.00 (a $180 savings over annual membership)

Transfer Fee $50.00

PAYMENTS COLLECTED ARE NON-REFUNDABLE

Click below to view TEAM Policies & Procedures:

Please check (Required for application submission):

I have read, understand and agree to all policies and procedures of TEAM Referral Network Corporation. I do agree to hold TEAM Referral Network, TEAM Franchise Corp, its franchisees, Directorates, contracted agents and affiliates harmless of any and all liabilities that may arise as a function of my membership as a TEAM Referral Network member and understand the TEAM Referral Network is an "at will" organization. * *