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Primary Membership Application
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*Important*
Primary Members shall be persons who are owners, managers, officers, or principal executives of the stated business. As membership is nontransferable, change of ownership or top management of the business, or termination of the Active member in that business, shall terminate the membership. The business may then designate another qualified person to apply for Active Membership and that person shall be given first and preferential treatment by the Board of Directors for that Active Membership. Alternatively, the Active Member, if continuing in the same business classification, may be considered for that Active Membership. – Article IV, Section 3, of the CSEA Bylaws
Business Name/dba
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Name of Sponsoring Member:
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Applicant's Name
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First
Last
Email
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Preferred Phone Number
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Preferred Phone Type:
Cell Phone
Office Phone
Home Phone
What is your current position and title?
*
Type of Business (select one)
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Individual/Sole Proprietor
LLC
Partnership
Corporation
Non Profit
Other
Principals
Please list all owners/key executives, with titles.
Nature of Business
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Briefly describe what your company does. Please provide as much pertinent information as possible, as this will be used to help determine the business classification.
Classification/Category desired
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How long have you been associated with this business?
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If less than two (2) years, what was your former occupation?
How long have you lived in the Colorado Springs vicinity?
*
Additional Information
Please provide any additional information you feel would be helpful to the Board in consideration of this application.
Business Communication Information
Mailing Address
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Address Line 1
Address Line 2
City
— Select state —
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Physical Address (if different)
Address Line 1
Address Line 2
City
— Select state —
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Applicant's Digital Signature
*
Type your name here to sign your application
Submit