Membership Application

• Application Information

• First Name Please enter your first name.
• Last Name Please enter your last name.
• Address Please enter your address.
• City Please enter your city.
• State Please enter your State.
• Zip Please enter your 5 digit zip code.
• Email Please enter your Email address.
• Website Please enter your website address.
• Phone Please enter your home phone number
• Cell Phone Please enter your Cell Phone Number.
• Birth Day & MonthPlease enter your Birth Day and Month.

• Business/Organization Information

• Name
• Are you a:
• CEO/Owner/President Entrepreneur Leader None of the Above
• Membership Level: Founders Corporate Share Corporate Full
• Meeting Time: Wed. AM

• Associations

  Select All That Apply, if any:
• Chamber of Commerce Kiwanis Rotary Other Other

• By submitting this form you acknowledge that all information is accurate and complete.  You also acknowledge that our primary form of communication is email.  Your application for membership will imply that you consent to receive our emails for ELC Roundtable communication and business.  We are always happy to take your email out of our system.  However, communication of meeting times, topics, news and events, and other ELC Roundtable related business will be effected.

  Please click submit below, to apply for membership.  Your facilitator will be in touch with you to discuss next steps.  Please contact the corporate office at (405) 753-9566, or steve@elcroundtable.com, if you do not receive a phone call or email within 24 hours of the submission of this application.

  Thank you  for applying for membership in ELC Roundtable,

Acknowledgement:

• I Agree I Do Not Agree You must accept the terms in order to submit your application.