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: