Please complete the following membership application.
*
indicates required
Name:
Email:
Comment:
Email Address
*
First Name
*
Last Name
*
Cell Phone
*
(
)
-
Work Phone
(
)
-
Home Phone
(
)
-
Address 1
Address 2
City
*
State (MI)
*
Zip Code
*
Company/Organization
*
Title
*
Birthday (MM/DD)
*
Month
/
Day
Birth Year
Required only to qualify for young professional discount (under 35)
Describe Work and Community Engagement Experience
*
Referring Member (if applicable)
