Membership Application
My reasons for joining:
(Please check your top three reasons)
Applicant Information
Information will appear on the online directory exactly as entered below.
* Required Fields
Networking Opportunities
Business Exposure
Business/Organization Name:*
Referrals
Street Address:*
City:*
Sponsorship Opportunities
State:*
Zip Code:*
Business Workshops and Seminars
SmallBizSUCCESSnet Listing
Website:
Company Email:*
My Own Web Site
Telephone:*
Facsimile:
Learn How to Start /Grow My Biz
Toll-free number:
 Publish my address:*
 YES
 NO
Access to Business Resources
Check all that apply:
Help Desk
Sole Proprietor
 Partnership
 Corporation
Mentoring
LLC
 Office-Based
 Executive Suite-Based
___________
Home-Based
Full-Time
Part-Time
Retail Company
 Network Marketing
Service Company
Internet Company
Franchise
 Independent Agent
As a Member of the
Small Biz
SUCCESS! Alliance
I pledge to
turn my dream into a
reality by
Primary Business Classification:*
Secondary Business Classification:
How many employees do you have including yourself?:*
What year was your business started:*
If your mailing address is different from the business address above
please enter it below:
  • Utilizing the services and
    products of "The
    Network" Members first

  • Giving referrals to "The
    Network" Members
    whenever possible

  • Making networking and
    developing business
    relationships a priority in
    my business

  • Continually setting new
    goals for the success
    of my business and

  • Helping others make their
    dreams come true!
Street Address:
City:
State:
Zip Code:
Primary Business Contact Person:*
Title/Position:*
Secondary Business Contact Person:*
Title/Position:*
Describe your business in 50 words or less:*
Do you offer a member-to-member discount?
YES
 NO
If YES, please describe:
How did you hear about Small Biz
SUCCESS! Alliance?
SUCCESS! Chapter
If you are joining a SUCCESS!
Chapter, please indicate your first
choice:
Membership is available exclusively to businesses with an annual revenue of less
that $750,000. (Businesses with larger revenues please contact us about affiliate membership.)
Beavercreek
Centerville
Does your business have an annual revenue of less than $750,000?
Columbus
YES
 NO
Dayton
Dayton North
Describe how you expect to benefit from membership w/Small Biz SUCCESS! Alliance.
Middletown
Springfield
---Membership Investment Options
SBSA Annual Membership Fee......................................>.............................220.00

SUCCESS! Chapter
Annual Membership..........................................................................................245.00

Small Biz SUCCESS! Alliance and SUCCESS! Chapter.............................365.00
Annual Membership

Small Biz SUCCESS! Alliance and SUCCESS! Chapter>>>>.........75.00/Down -
25.00/mo.***
Annual Membership

Rules, Regulations and By-Laws.

We respect your privacy and will never share or sell your information.

Small Biz SUCCESS! Alliance membership is effective when payment is received.
Membership is billed to an authorized credit/debit card monthly. Membership
may be cancelled with written notice. Refunds will be pro-rated and credited
within 10 days. Checks are accepted for annual memberships only.

**There are no membership refunds. Two employee/associates are recognized
as members and may participate in all activities and benefits.

***Must be billed to a credit card on a monthly recurring basis.

Membership may be tax deductible as an ordinary and regular business
expense. Please consult your tax professional.

1-888-562-5126  -  www.SmallBizSuccess.net