Membership Application

Thank you for your interest in joining ConnectONCE. Our Board of Directors will review your application and you will receive an invoice for membership fees if approved. Your membership becomes active once you have paid your membership fee. Please contact Member Services if you have any questions.

Company

Organization/Company Name

New Member Contact Information

First Name

Last Name

Business Title

Department

Email Address

Business Phone

Business Address Line 1

Business Address Line 2

City

State/Province

Country

Postal Code

Administrative Assistant's Name

Administrative Assistant's Phone Number

Administrative Assistant's email address

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Company Profile

Organization/Company Website

Type of Organization Type of Organization

Industry Focus Industry Focus

State or Country of Incorporation

Years in Business

Approximate Number of Employees

Approximate Annual Sales (specify currency)

Brief Description of Company, Products, and/or Services

Public Relations

Director of Public Relations

Email Address

Accounting

Accounting Contact Name

Accounting Department Email

Accounting Phone Number

Is your Accounting Department Address different from your Business Address?

Yes

Accounting Address Line 1

Accounting Address Line 2

City

State/Province

Postal Code

How did you hear about ConnectONCE?

(Conference Speaker, Trade Show, Browsing the Web, Colleague, Employee, etc.) Please provide as much information as possible.

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