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SBAN New Member Interest Form
Please complete this form with your basic information to begin enrolling as an SBAN Member.
For enhanced tiers (paid memebership with extended benefits), please click
here
.
* Indicates required question
Email
*
Your email
First Name
*
Your answer
Last Name
*
Your answer
Organization Name
*
Your answer
Role/Title
*
Your answer
What tier level are you purchasing
*
Choose
Equity Advocate ($150) - one member (individual or organization)
Community Champion ($500) - two to four organization staff members
Empowerment Ambassador ($1000) - up to ten organization staff members
Sponsor Trailblazer ($5000) - up to ten organization staff members
Free Tier- limited access for one member
If you are joining at the Community Champion level or above, please indicate the
first name, last name, email and job title
of the other members of your organization you would like to provide access to.
Your answer
Please indicate which of the staff members listed above you would like to serve as your organization's primary contact for member-related communications.
Your answer
A copy of your responses will be emailed to the address you provided.
Submit
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