KINGMAKERS Tampa
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Application
MEMBERSHIP PROPOSAL FOR BOARD APPROVAL
FULL NAME (Dr. / Mr. / Mrs. Ms.)
date of birth
SPOUSE NAME (Dr. / Mr. / Mrs. Ms.)
Date
BUSINESS / EMPLOYER
industry
POSITION / TITLE
years with company
BUSINESS ADDRESS
City
State/Province
ZIP / Postal Code
HOME ADDRESS
City
State/Province
ZIP / Postal Code
CELL PHONE
BUSINESS PHONE
HOME PHONE
SPOUSE PHONE
EMAIL
SPOUSE EMAIL
NUMBER OF YEARS IN COMMUNITY
FORMER RESIDENCE (City & State)
GRADUATE OF THE FOLLOWING UNIVERSITY (s)
MEMBER OF THE FOLLOWING CLUB (s) AND / OR FRATERNAL ORGANIZATION (s)
I am acquainted with three (3) directors of KINGMAKERS Tampa as follows:
A letter of recommendation is required from a current member of KINGMAKE Tampa before this candidate can be considered - this member will be stated s A photograph of the proposed person is encouraged. Membership proposals not have the required letters of recommendation will not be considered or el to be added to the membership ballot for approval.
full name of sponsor (printed)
how acquainted?
ADDITIONAL INFORMATION / CHILDREN'S NAMES
NAME
DOB
NAME
DOB
NAME
DOB
NAME
DOB
ADDITIONAL INFORMATION / PETS
NAME
BREED
NAME
BREED
NAME
BREED
NAME
BREED
Please mail monthly statements to (please check one):
Business Address
Home Address
Please mail Club newsletter & social information to (please check one):
Business Address
Home Address
SIGNATURE OF APPLICANT
date
Submit
