Membership Application

    Organization Name:

    Address:

    City:

    State:

    Name of Chief Staff Executive:

    Title:

    Phone:

    Email Address (required):

    Website:

    Name of Second Contact:

    Title of Second Contact:

    Email Address of Second Contact:

    Please briefly outline the nature of your organization and the type of member and industry you represent:

    Number of Members:

    Amount of SBLC Dues based on the potential member’s total association budget:

    •If your association’s total budget is less than $500,000, your dues are $950.
    •If your association’s total budget is $500,000 to $1 million, your dues are $2,250.
    •If your association’s total budget is $1 million to $2 million, your dues are $2,800.
    •If your association’s total budget is $2 million to $3.5 million, your dues are $3,375.
    •If your association’s total budget is $3.5 million to $5 million, your dues are $3,925.
    •If your association’s total budget is $5 million or more, your dues are $4,500.

    $

    Mail completed dues check to:
    Small Business Legislative Council
    Attn: Katherine Glenn
    4800 Hampden Lane, 6th Floor
    Bethesda, Maryland 20814

    MEMBERSHIP ELIGIBILITY:
    SBLC membership is open to associations whose members are predominantly small businesses or independent professionals.

    Please type your name for Electronic Signature: