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Membership Application Form
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Contact Information:
First Name
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Please let us know your name.
Last Name
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Email Address
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Mailing Address
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Street Address
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Billing Contact
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Membership Tier (please select one):
Individual Partner ($50-$99)
Business Partner ($100-$499)
Silver Partner ($1,500-$3,000)
Non-Profit Partner ($50+)
Community Partner ($500-$1,499)
Gold Partner ($3,000+)
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Names and emails of employees who would like to receive event notices:
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Please indicate which professional development groups you are interested in:
Business Roundtables
Business Planning Workshops
Other
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Payment Method
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Please make checks payable to JLDC and mail to P.O. Box 1079, Whitehall, MT 59759, or request other arrangements below
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Print & fill out form (Payment enclosed)
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