Company Membership Application

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Company: Prefix: First Name: Middle Initial: Last Name: Suffix: Title: Department: Web Site: Email: Primary phone (cell preferred) Evening phone:

Company Address:

Address Line 1 Address Line 2 Address Line 3 City: State: County or Province (Foreign) Zip or Postcode: - Country: Membership:

Individual - Annual Plan, Paid Monthly ($8 pm)

Individual - Annual Plan, Paid in full ($86.40 pa incl 10% discount)

Partners & Corporate - Annual Plan, 3 members package - All Britsburgh Societies ($228 pa)

Partners & Corporate - Annual Plan, 5 members package ($350 pa)

Partners & Corporate - Annual Plan, 10 members package ($650 pa)

By ticking this box I acknowledge that this membership will be automatically renewed, unless cancelled after 1 year. (Optional)

You may cancel this membership within three business days of your join date and receive a full refund. After that this membership is non-cancelable and non-refundable for a period of one year from the join or renew date.

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The Britsburgh Team