MEMBERSHIP APPLICATION FORM (Valid July 1st 2015 to June 30th 2016) NAME OF ORGANIZATION: (The “Organization” will be the “Member” in the BC CEO Network) NAME OF CEO REPRESENTATIVE: *Optional - 2nd CEO Representative: ORGANIZATION ADDRESS: MAILING ADDRESS (IF DIFFERENT FROM ABOVE): TELEPHONE NUMBER: FAX NUMBER: E-MAIL ADDRESS of CEO REPRESENTATIVE: E-MAIL ADDRESS of 2nd CEO REPRESENTATIVE: Brief summary of your organization and the services you provide: TYPE OF MEMBERSHIP: FULL MEMBER (Voting) (Mid-year applications 6.1.1 B will be pro-rated quarterly) The FULL membership fee is calculated as 1/10 of u 1% of your “Total Organization Operating Budget” with a minimum of $500 and a maximum of $3500 plus GST. This membership provides input to the strategic s initiatives of the CEO Network, attendance at General Meetings and training sessions, and a vote at CEO Network General i purposes of the CEO Network. Meetings. Networking with your fellow CEO’s is one of the primary n ASSOCIATE (Non-Voting) $125 per year pluseGST. This membership is available to agencies who have a total operating budget of $1,000,000 or less. It provides information s updates, access to the BC CEO Network Website and attendance to our training sessions for a fee. This membership does s not provide a vote or attendance at general meetings. MICRO-BOARD (Non-Voting) $100 per year plusMGST. This membership is available to Microboards and provides informational updates, access to the BC CEO Network Website. e This membership does not provide a vote or attendance at general meetings or training sessions. m b e TOTAL ORGANIZATION OPERATING BUDGET: r MEMBERSHIP FEE: s h “My Organization is applying for Membership in the BC CEO NETWORK, by my signature below.” i p Signature of CEO Representative named above Date of application : Please return this form to: BC CEO NETWORK – MEMBERSHIPS, 950 Kerry Street, Prince George, BC V2M 5A3 or Fax to (250) T 564-6924 or e-mail to: [email protected] You will receive an invoice via e-mail once we receive your completed form. Once full payment is received, we will confirm h your Membership in the BC CEO NETWORK. Your e-mail address will then be added to the “BC CEO NETWORK i MEMBERSHIP” distribution list. A receipt will be e-mailed to you at the e-mail address you have identified above. s