Meetings 2nd Tuesday of each month @ 11:45AM
Place: Crowne Plaza 14670 Duval Rd. Jacksonville, Fl. 32218
MEMBERSHIP APPLICATION
Name __________________________________________________Date_____________________
Business Name __________________________________Occupation________________________
Business Address_________________________________________________________________
Zip Code ___________________Business Phone ___________________Ext __________________
Fax Number_______________ Bus. Category ___________________________________________
Home Address ____________________________________________Zip Code__________________
Home Phone_________________________________Email _________________________________
Birthday (mm/dd)_______________Spouse Name__________________________________________
Category of Membership (Circle): Individual Corporation Ret. Spouse
I am interested in serving on the following Committee(s) (Circle)
Annual Banquet Directory Finance Scholarships Web Page
Government Affairs Membership Programs Golf Tournament
Sponsored by: ______________________________________________________________________
Signature of Applicant:_________________________________________________________________
One Time Application Fee 25.00 Annual Dues Individual 115.00
Annual Dues Corporate 300.00 Annual Dues Ret. Spouse 35.00
MAIL APPLICATION TO: Northside Business Leaders; P. O. Box 28554; Jacksonville, Florida
32226-8554
QUESTIONS/CONTACT northsidebusinessleadersclub@gmail.com