Associate Membership Application

** To be completed by Primary Member of company or organization ** Associate Membership shall be limited to managers, executive heads, or business representatives of Active Members, subject to the approval of the Board of Directors. Associate Members shall not be entitled to vote and shall pay not dues. -Article IV, Section 6, of the CSEA Bylaws

Name of person applying for Associate membership. *

Applicant's Phone (with extension) *

Check One *

This Associate Member is a new Associate Member
This Associate Member is in addition to a current Associate (two Associate members/company)
This Associate Member replaces a current Associate

I (Primary member) wish to name the following person as an Associate for our company/organization *

As the Primary member, I understand that this Associate is not being considered a regular replacement for myself at weekly meetings.

What is the nominee's position and title? *

How long has the potential Associate Member been in the position indicated? *

How long has the nominee been associated with this business? *

If less than two (2) years, what was the nominee's former occupation?

How long have you know the nominee? *

How long has the potential Associate Member lived in the Colorado Springs vicinity? *

Please provide any additional information you feel would be helpful to the Board in considering this nominee for Associate Membership

Primary Member Information

Primary Member Phone (with extension) *

Primary Member Email *

Primary Member Digital Signature *

To the best of my knowledge, this person is of good character, ethical in business, and an outstanding representative of our company/organization.