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British-American Business Council Houston

P O Box 421234
Houston, TX 77242-1234
Ph 832.351.3940
Fx 832.351.3942


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BABC Houston Membership Application

 
Section 1: User Information
First Name*
 
Initials
 
Last Name*
 
Company
 
Title
 
Functional Title
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Address*
 
City*
 
State*
 
Zip Code*
 
Country
 
Phone*
 
Work Phone
 
Home Phone
 
Mobile Phone
 
Pager
 
Fax
 
E-mail*
 
Web Site
 
DOB
 
Gender
 
Spouse
 
UD1
 
 
Section 2: Additional Addresses
Same as Primary Address   
 
Address
 
City
 
State
 
Zip Code
 
Address Type
 
 
Section 3: Membership Information
Certifications
 
Areas of Expertise
 
Primary Practice
Industry
 
Referral Source
 
Referral Source Other   
 
Referral Source Member Name
Referral Source Member Number   
 
 
Section 4: Membership Type
Membership Type*
$5,000.00 - Platinum Sponsor
$2,500.00 - Gold Sponsor Member
$2,500.00 - Platinum Membership Prorated after July 1
$1,250.00 - Gold Member Prorated after July 1
$650.00 - Corporate Member
$325.00 - Corporate Prorated After July 1
$300.00 - Small Business Member
$150.00 - Individual
$150.00 - Non-Profit
$150.00 - Small Business Prorated after July 1
$75.00 - Individual Member Prorated After July 1
$25.00 - Student
 
 
Section 5: Payment
Payment Method*
    Credit card
    Cash
    Check
    Wire transfer
    Send invoice
 
 
Section 6: Directory Listing
 

Your directory listing will be listed in a PUBLIC directory and included in the directory RSS feed for this site. Please do not include private information that you do not want made public in your directory listing.

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E-mail
 
Headline
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Summary
 
Body
 
 
Section 7: Career History
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