PLEASE NOTE: If this is a MEMBERSHIP RENEWAL, please click here.

New Member Application for the International Group
To apply for membership in the All Cities International Group, please fill out the blanks below (may be entered from keyboard) and follow the instructions at the bottom.

Name: (first name, middle initial, last name)

Title:

Company/Organization Name:

Address: (#, street, suite # or fl #, etc.)

City, State Zip:

Phone: (area code-phone number)

Fax: (area code-fax number)

E-mail:

Website:

Category: Select one

Please answer the following questions:

In what city do you reside?

What is your educational background?

Referred by?

Who is your best referral source?

What is your profession/specialty?

Do you hold any professional designations?

How long in your profession?

Who is your typical client?

Do you own your own business?

Who do you refer business to?

What other groups, associations, or organizations do you belong to or participate in?

  • PLEASE NOTE: This is a membership in the International Group ONLY.
  • Both your personal and business bio’s must accompany this application. Photos (head shots) can be taken at any All Cities Network Mixer.
  • As a Member, you will be required to fulfill only two additional requirements:
    • First, we ask you to make meeting attendance a priority.
    • Second, and of key importance to keeping the group fresh, is that you bring at least one qualified guest every four months
  • If you desire a membership upgrade, please see Eric or your moderator. Membership upgrades are available for International Group members at a reduced rate

Thank you for your interest in the All Cities International Group.
Please print out, mail/fax with check or credit card payment $500.00 to

Eric Shaw, President
All Cities Intenational Group
929 Howard Street
Marina del Rey, CA 90292

Phone: 310-827-0076
Fax: 310-578-0077
Email: eric@nycreditinc.com
CREDIT CARD PAYMENT FORM

TO:______________________

______________________

______________________

FAX NUMBER_____________

The All Cities Network (All Cities Resource) is pleased to accept Visa, Mastercard, and American Express. We cannot, however process your payment unless all information requested below is filled out properly. It must be signed and dated as well.

Please complete this form and fax it back to the All Cities fax 310. 578.0077 >> Attn: Remi Shaw

COMPANY / Personal NAME

(only if applicable)__________________________________________

NAME APPEARING ON THE CARD__________________________________

BILLING ADDRESS FOR CARDHOLDER_________________________________________

_________________________________________

(Need full street address and zip code to process)

CARD NAME (Visa, MasterCard, American Express)_________________________________

CARD NUMBER_____________________________

THREE OR FOUR DIGIT SECURITY CODE________________________________________

(AMEX = four digit on front of card above card # // VISA or MC= three digit on back above signature)

DOLLAR AMOUNT CHARGED $_________ CARD EXPIRATION DATE(MM/YY)__________

CARD HOLDER SIGNATURE AND DATE:

_________________________________ ______________________