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

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)?*

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

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 $240. Lunch meetings are $25 prepaid online or $30 at the door.

RTA Annual Membership*

Price: $240.00

Optionally pre-pay for up to 12 lunch meetings

Price: $25.00 Quantity:

Total

$0.00

Credit Card*

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