MY SUCCESS GROUP MEMBERSHIP FORM

APPLICANT NAME / BUSINESS:
________________ / ______________

Please print out, fill out, and hand deliver to: Patty Smith
-----------------------GUESTS-----------------------
NAME DATE
1)  
2)  
3)  
4)  
5)  
-----------------------1 on 1 MEETINGS-----------------------
NAME DATE
1)  
2)  
3)  
4)  
5)  
-----------------------REFERRALS-----------------------
NAME DATE
1)  
2)  
3)  
4)  
5)  
-------------------DATES OF MEETINGS ATTENDED-------------------
1)
2)
3)
4)
5)
My Success Group is a group of professionals who come together to fellowship and pass referrals as well as enrich their personal and professional lives. As a member of this group you are letting those around you know that you are dedicated to increasing their business through the giving and receiving of referrals. We come together as professionals, promoting our businesses and the businesses of those we meet. We agree to maintain our highest level of professionalism, respect, morality and ethics. We want our children, spouses and friends to feel comfortable attending our group as well as fellow business associates.