MLMIA - Corporate Membership Application

Company Name:

President / CEO:

Address:

City:

State:

Zip:

Phone:

Fax:

Fax On Demand:

Email:

Web Site:

Mailing Address (If different from above):

Your company is entitled to 2 additional officer/staff representatives - Only company representatives may vote or hold office.

Representative:

Title:

Representative:

Title:

CORPORATE MEMBERSHIP DUES

$1,000--First Year of Operation - Under 1,000 Distributors

$2,500--1001 to 5000 Distributors

$4,000--5,001 to 10,000 Distributors

$5,000--10,001 to 25,000 Distributors

$7,500--25,001 to 50,000 Distributors

$10,000--over 50,000 Distributors

Method of payment:

Check - payable to MLMIA

Visa

AmEx

MasterCard

Credit Card Number:

Expiration Date:

Print Name On Credit Card:

Signature:

We hereby apply for membership in the Multi-Level Marketing International Association (MLMIA). We understand that to be accepted for active membership we agree that we (a) will operate in a professional manner with high moral standards, (b) will subscribe to and uphold the principles and ethics prescribed by the Association, and (c) will continually strive to meet all requirements and standards established by the Association. We understand that to remain a member in good standing our membership must be renewed anually.

Signature:

Date:

OFFICE USE:

EX

QB

MS

DJ

ECD

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