Mayors Business Council Membership Application
Sign in to Google to save your progress. Learn more
Email *
Did  anyone on USCM staff work with you to join the Business Council?  If so, please provide their name below.   *
Applying Organization (Name as it should be listed online) *
Membership Year *
Membership is non-transferable.  Only staff from your organization can register and attend USCM meetings.  *The Primary Representative will receive the yearly membership renewal invoice, unless otherwise requested.
The person(s) listed below will represent your organization on the Mayors Business Council and is authorized by your organization to receive all correspondence and benefits of the Mayors Business Council.  Anyone from your organization (not just the two representatives below) can register for our meetings and can use the two complimentary registrations.  
*Name of Primary Representative: *
Primary Representative Title *
Primary Representative Street Address *
Primary Representative Suite/Floor/Etc.
Primary Representative City/State/Zip *
Primary Representative Office Phone# *
Primary Representative Cell Phone# *
Primary Representative Email Address *
Secondary Representative Name:
Secondary Representative Title
Secondary Representative Street/Mailing Address
Secondary Representative Suite/Floor/Etc.
Secondary Representative City/State/Zip
Secondary Representative Office Phone#
Secondary Representative Cell Phone#
Secondary Representative Email Address
Corporate Headquarters
CEO/Founder Name
Title (if not CEO/Founder)
Street/Mailing Address
City/State/Zip
Please provide a Description (300 words or less) of your Organization: *
Company Website
25,000 (January - December)  MEMBERSHIP ANNUAL DUES: *
Annual membership dues are $25,000 (January 1-december 31).  If it's more convenient to pay via credit card, please use the following link to make the payment online.  https://www.usmayors.org/product/payment/   (You may need to copy and paste the link to your browser.)
a)     In the “Name Your Price” space, type in dollar amount (no spaces, commas, no periods, e.g. $25,000.00 should be entered as 25000)
b) Then click “Add to Cart”                                                                                                                                                  
c) Then click “View Cart” button right
d) Then “Proceed to Checkout”    
e) Then complete the “Billing Details”.  The rest should be self-explanatory.                                                                                                                
If you have any questions, please contact Geri Powell, Managing Director of the Mayors Business Council at gpowell@usmayors.org or 202-861-6774.
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of United States Conference of Mayors. Report Abuse
Google Forms