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
Primary Business Classification:*
As a Member of the
Small Biz SUCCESS!
Network
I pledge to
"Work my Network"
by
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! Network?
For what city are you joining?*
Columbus
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.)
Dayton
Middletown
Does your business have an annual revenue of less than $750,000?
Springfield
 YES
 NO
Describe how you expect to benefit from membership w/Small Biz SUCCESS! Network.
*MBR Alliance memberships only.
---Membership Investment Options
Small Biz SUCCESS! Network only
Monthly Membership Fee.................................................................................. 20.00

Annual Membership Fee..................................................................................220.00

MBR Alliance only**
Annual Membership..........................................................................................245.00

Small Biz SUCCESS! Network and MBR Alliance......................................365.00

Rules, Regulations and By-Laws.

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

Small Biz SUCCESS! Network 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.

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

Membership may be tax deductible as an ordinary and regular business expense. Please
consult your tax professional.
2555 South Dixie Drive, Suite 206   Dayton, Ohio 45409     1-937-396-2
www.SmallBizSuccess.net
Small Biz SUCCESS! Network