To send in your voting member application with your membership fee
Highlight, copy, paste, print, complete, sign and return the application below.
How do I do that?      pdf Version

Voting Membership Application & Registration For
 [] Business Annual Membership = 3 votes ($500) 
[] Nonprofit Annual Membership
=3 votes ($350) 
[] Lifetime 2100 Membership = 3 votes ($2100) 

Name of the
Organization
Street   City  
Zip  
Phone
 
Fax
 
Website
 
Please Register the following employees
You receive ten Starter Memberships as part of your membership.
#
Employee Name
Phone
Email
1
 
Home
Work
   
2
 
Home
Work
   
3
 
Home
Work
   
4
 
Home
Work
   
5
 
Home
Work
   
6
 
Home
Work
   
7
 
Home
Work
   
8
 
Home
Work
   
9
 
Home
Work
   
10
 
Home
Work
   
During the first 30 days of your membership you can buy additional Starter Memberships for $35/each.
11
 
Home
Work
   
12
 
Home
Work
   
13
 
Home
Work
   
14
 
Home
Work
   
15
 
Home
Work
   
16
 
Home
Work
   
17
 
Home
Work
   
18
 
Home
Work
   
19
 
Home
Work
   
20
 
Home
Work
   
Revocable Proxy Statement for Voting Members

 “The undersigned, as a member of Chimorel Services Inc, hereby appoints the Executive Director or his/her designee, the proxy and attorney of the undersigned, with full power of substitution to attend all meetings of members and to vote for me in my place and stead upon all matters properly coming before such meetings. The undersigned hereby ratifies and confirms all that said proxy and attorney may do by virtue hereof. The undersigned hereby reserves the right to revoke this proxy at any one or more meetings by attending and voting three votes in writing at such meeting or meetings. This proxy will remain in effect for all meetings which the undersigned does not attend and vote in writing, except that returning a ballot by mail/email shall also constitute revocation of this proxy for and only for the meeting for which said ballot is returned.”

Your signature(s) & date below accepts the terms and conditions for the membership you have applied for as described on the next screen.

Chief Executive Officer________________________________ Secretary ___________________________________ Date ___/___/12


Terms & Conditions of an Annual
Nonprofit or Business Voting Membership
© The Chimorel Group 2005