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LT Senior Services Member Application
If you need help with this form call (512) 766-3658 or email
info@ltseniorservices.org
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* Required
What is the name of your business?
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Your answer
What is your name?
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Your answer
What is your contact phone number?
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Your answer
What is your email address?
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Your answer
Business Street Address
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Your answer
City
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Your answer
State
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Your answer
Zip Code
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Your answer
Mailing Address
If different from above
Your answer
Business Phone Number
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Your answer
Business Website
Your answer
Business status
For-Profit
Non-Profit
Do you want to be included in the Speakers Bureau, and if so, what topic would you speak on?
Your answer
Do you want to be a speaker at one of the quarterly networking meetings, and if so, what topic would you speak on?
Your answer
Do you want to host a quarterly meeting? What is your availability (January, April, July, October)?
Your answer
Would you like to participate in a committee? If so, which?
Business Networking and Development- Membership Outreach, Monthly logistics such as speaker and location.
Public Awareness and Education- Seminars for Aging Adults, Aging Well Conference, Speakers Bureau.
Community Outreach and Support- Community projects to support Aging Adults both financially and with volunteer time.
Marketing- Web Page, Brochure, Facebook page, Blog, Press releases.
Other:
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Registration fee
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Choose
$150 for 2022 - Business Owners Registration
$50 for 2022 - Non-Profit Organization
Please provide a 50 word description of your business
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Your answer
Payment Agreement
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I understand that I must submit payment via QuickBooks or via US mail within 7 days of the submission of this form.
Need to pay by CC
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