Interest Form ~ AYP Member of the Month
Thank you for your interest to be AYP's Member of the Month!

Please review the overview and process at the following link before completing the form below.
https://docs.google.com/document/d/1fsKYiNkCozXK8F4drwAwi-gli9Bf5g0n9Lvri-h4S5A/edit?usp=sharing

Please reach out to AYP Incoming Chair Dustin Nichols with any questions - dustin@lakeside-insurance.com
Email address *
Your Name *
Your answer
Business/Organization Name, Job Title and years in your industry? *
Your answer
The following months are currently available. Please let us know below which month you would like to sign up for. Consider if you have any events that might align with certain months and would be a good promotional opportunity. Please indicate below what your preference is 1st 2nd and 3rd.
2019
November

2020
January
February
March
April
May
June
July
August
September
October
November
December
What month would you like to be Member of the Month? *
Your answer
By clicking YES, you have read and understand the Overview and Process for Member Spotlight - please see the link above. Please reach out to Dustin Nichols with any questions at dustin@lakeside-insurance.com Thank you for your interest and we'll get back to you shortly! *
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