Membership Application – Rising Tides Alliance

Rising Tides Alliance is looking for the most powerful networkers in the Westchester County Area.

We are opening up our membership and looking for businesses that are located in or service the Mid-Westchester Area. To join RTA complete the following application and purchase your annual membership below.
Required Business Information
Name*
First Last
Email*
Business Name*
Business Type / Industry*
Office Phone*
Mobile Phone*
Business Address*
Street Address Address Line 2 City State ZIP Code
Business Website
What is your mail goal of joining RTA?*
What categories do you currently have business relationships with and who are they?*
What business relationships would you like to see more of?*
Who referred you to RTA?*
What panel topics interest you?*
Are you currently working with any non-profit organizations? If so, which one(s)?*
Headshot
Please upload a professional headshot or photo to be featured in your public website profile
Accepted file types: jpg, jpeg, gif, png, webp, Max. file size: 10 MB.
Optional Personal Information
The information below is not mandatory; however, we would like to get you know you better.
Home Address
Street Address Address Line 2 City State ZIP Code
Birthday
MM slash DD slash YYYY
Marital Status
Hobbies and Community Interests
Do you have any children?
- Yes
- No
Number of children
Children's ages
Payment Information
Annual membership for RTA is $250. Your membership will automatically be renewed and charged on an annual basis unless canceled in advance.

Lunch meetings are $30 prepaid online or $35 at the door.
RTA Annual Membership*
Price:
Optionally pre-pay for up to 12 lunch meetings Quantity
Price: $30.00
Total
$0.00
Credit Card*

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
Credit card billing address*
- My credit card bills are sent to the business address filled out above
- Please allow me to specify a different billing address
Credit Card Billing Address*
Street Address Address Line 2 City State ZIP Code

Required Business Information

Optional Personal Information

Payment Information