CSEA Member

Important

Retired Primary Membership may be granted by the Board of Directors to a former Primary Member. They shall pay no admission fee but shall pay dues and shall not be entitled to vote but shall be entitled to all other privileges of a Primary Member.

Applicant's Name *

First

Last

Email *

Preferred Phone Number *

Preferred Phone Number type, for potential member:

Cell Phone
Home Phone

Name of company from which you retired: *

Is someone at your former company desiring to become a participating member of Execs? *

Yes
No

If someone at your former company desires to become a participating member of Execs, please provide the person’s name and number because we will need to obtain an application from that person. Note: It is extremely important to CSEA that when a former member is granted Retired membership, we replace the former membership with a new membership, whether that is from the same company or a company that you, as the retired member, see fit for CSEA. You will help us in that process by making the recommendation.

Name of potential member *

Preferred phone number of potential member:

Preferred phone number type:

Cell Phone
Work Phone
Home Phone

Nature of Business/classification/category held in Execs *

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.

How long were you associated with this business? *

Additional Information

Please provide any additional information you feel would be helpful to the Board in consideration of this application.

Communication Information

Mailing Address *

Address Line 1

Address Line 2

City

State

Zip Code

Physical Address (if different)

Address Line 1

Address Line 2

City

State

Zip Code

Applicant Digital Signature *

Type your name here to sign your application

Retired Membership Application

Important

Communication Information

Colorado Springs Executives Association

Retired Membership Application

*Important*

Communication Information

Colorado Springs Executives Association

Important