Membership Application

Your Information

* Indicates required field

First Name *

 

Last name *

 

Email Address (Will Be Used As Your Login as Well) *

 

Phone Number *

 

Company Name *

 

Website *

 

Industry *

 

Which Chapter Do You Wish To Join *

 

How did you hear about BusinessGPS *

 

Can you attend weekly? (A core requirement of membership acceptance) *

Yes

No

Billing Information

Name As It Appears On The Card *

 

Card Type *

 

Expiration Month *

 

Expiration Year *

 

Billing Zip Code *

 

Card Number *

 

Security Code *

 

Charges

BusinessGPS Initial Investment....................................................................................................................................$100.00

 

BusinessGPS Monthly Membership...............................................................................................................................$29.95

Total Due Upon Application Acceptance....................................................................................................................$129.95

Acknowledgement *

By Checking this box, you agree to the terms and conditions set herein and you understand that the information you have provided is true and accurate to the best of your knowledge.

Recurring Payment Authorization. By Checking this box you acknowledge the monthly recurring amount of $29.95 will be charged monthly for your BusinessGPS membership until a cancellation request is received.

 I agree to receiving marketing and promotional materials

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