Lexington Business Association
Business Networking Group Application
Membership / Member Profile

NAME: __________________________________________________

APPLICATION DATE: _________________________________________

BUSINESS INFORMATION

BUSINESS NAME: _____________________________________________________

WEB SITE: ___________________________________________________________

EMAIL ADDRESS: _____________________________________________________

BUSINESS TELEPHONE #: ___________________________________________

CELL PHONE #: _____________________________________________________

FAX #: ___________________________________________________________

YEARS IN THIS BUSINESS: __________________________________________

DESCRIPTION OF YOUR BUSINESS: _____________________________________

______________________________________________________________________

PERSONAL INFORMATION

YOUR BIRTHDAY: _____________________________________________________

SPOUSE’S NAME: _____________________________________________________

CHILDREN: __________________________________________________________

HOBBIES: __________________________________________________________

ACTIVITIES OF INTEREST: __________________________________________
Click the "Print this Application" button to produce a copy of the CBSRC membership application.