MEMBER APPLICATION
Print this application and send in with $38 program fee.

Name: ____________________________________________________________________________________

Business Name: ____________________________________________________________________________

Mailing Address: ____________________________________________________________________________

Phone: ___________________________________  Email: __________________________________________

Website Address: ___________________________________________________________________________

How did you hear about DRP? _________________________________________________________________

What kind of business are you looking for? Be specific, and if you are limited to a portion of your business due
other member's exclusivity, let us know that:

___________________________________________________________________________________________

___________________________________________________________________________________________

Do you have a preference to which group you are in? If so, which one? _________________________________

Policies: You must be a member of the Maumee Chamber to participate. Please read the information outlined
on the Dynamic Referral Partners web page. You must be willing to abide by the policies and rules outlined. No
refunds will be given once you participate as a member at a meeting. If your application is not accepted for
whatever reason, your $38 program fee will be returned. Someone will contact you as soon as we receive your
application.
I have read the requirements and agree to abide by them.

Signature: ________________________________________________  Date: ___________________