Membership Application

APPLICANT CONSENTS TO A REFERENCE CHECK ON THE COMPANY PROPOSED HEREIN FOR MEMBERSHIP. APPLICANT CONSENTS TO PUBLICATION OF ITS NAME IN AXA BULLETIN AS PROPOSED MEMBER. THE ACCEPTANCE OF THIS APPLICATION FOR MEMBERSHIP SHALL NOT BE CONSIDERED BINDING ON EITHER THE PROSPECTIVE MEMBER OR AXA UNTIL (1) APPROVED BY THE BOARD OF DIRECTORS AND (2) RECEIPT OF THE MEMBERSHIP FEE BY THE EXECUTIVE DIRECTOR. UPON SATISFACTION OF BOTH THESE CONDITIONS, THE MEMBER SHALL BE ENTITLED TO ALL THE PRIVILEGES OF AXA AND AGREES TO ABIDE BY THE BY-LAWS OF THE ASSOCIATION AND AGREES TO CONFINE BUSINESS PROMOTION EFFORTS TO CLASSIFICATION ASSIGNED ONLY. MEMBERSHIP SHALL NOT, HOWEVER, BE GRANTED TO AN APPLICANT IF THAT APPLICANT IS PRESENTLY, OR SUBSEQUENTLY BECOMES AFFILIATED WITH AN ORGANIZATION WHICH HAS SUBSTANTIALLY SIMILAR OBJECTS TO THOSE SET FORTH IN ARTICLE 1, SECTION 3 OF THESE BY-LAWS.

Classification Requested

 

Sponsor / Relationship

 

Firm Name

 

Physical Address

 

Mailing Address

 

Billing Address

 

Phone

 

Fax

 

Email

 

Website

 

Business Type

Business Type :: Manufacturing / Retail / Service / etc.

 

Number of Local Employees

 

Number of Years operating in Capital District

 

Representative Title

 

Representative Name

 

Home Address

 

Representative Phone

 

Date of Birth

 

Spouse Name

 

Alternate Title

 

Alternate Name

 

Home Address

 

Alternate Phone

 

Date of Birth

 

Spouse Name

 

Do you, your organization or anyone in your organization presently belong to any other networking / lead generation group(s)?

 

Other Organizations

No    Yes

 

Name of Organization

 

AXA is a category-based membership organization that enables members to refer or direct other members to business opportunities without conflict of business involvement. Therefore:

 

A) Please describe the specific category that you are applying for and indicate the percentage of its business in relationship to your overall business strategy:

 

Category Description

 

B) please describe your application in relationship in your company's organization (i.e., subsidiary, holding company, or division of a regional or national company):

 

Organization Description

 

All competitors in this market:

 

Competitors

 

Business References (including AXA):

 

Business References

 

The membership committee reserves the right to interview any or all applicants to AXA. Once completed, your application will be posted for two (2) weeks. Without objection, a decision will be made by the board of directors at its next scheduled meeting. Application fees will be returned if your application is not accepted.

 

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