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: