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Membership Application Form
Your Company *
Position in Company *
Address *
Street, City, State and Zip
Telephone *
Cell Phone
Email *
Number of Employees *
Company Website *
Business Category *
Description of Business *
Additional Product Lines
Full Name of Primary Representative *
Must be Owner, Partner or Executive Officer
Other Professional and Non Profit Organization Memberships
Alternate Member Name *
Alernate Member Email *
Alternate Member Phone
BEA Agreement
We hereby make application for membership in the Business Executives Association and agree, if approved, to comply with the requirements of membership, as spelled out in the Bylaws of the organization, as amended from time to time. We understand our application fee of $250 is refundable only if the Board of Directors disapproves our application.

To the extent the following requirements of membership are not in conflict with the Bylaws, we agree:

1. To make every effort as often as possible to provide bona fide leads that could benefit one or more members.

2. To attend in person each and every Regular, Special and Social Meeting unless prevented by sickness or urgent business reasons, in which case the Alternate Representative would attend.

3. To familiarize myself with the various lines of business of the members of the BEA and make proper recommendations, whenever possible.

4. To act promptly on all leads received, following up and making every effort to turn such leads into profitable business.

5. To pay dues (at $125/month) within the terms offered, with a check for the first six months dues to accompany the Application. This check will be returned if the Application is withdrawn or not approved. After the six month period, dues shall be billed and automatically deducted monthly.

6. To hold information received from the BEA in strict confidence, as appropriate.
Electronic Signature *
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