First & Last Name * Your Email * Cell Phone Work Phone Preferred Contact Method CellWork Business Name * Business Website Business Description Business Address * What is your position at the company? * How many employees does your company employ? * How many locations does your company have? * How long have you worked in this profession? * How long have you been with the company? * Membership & Dues (Updated) • LWRRP will send 2026 invoices in December; due by Jan 23 (week before Kick-off dinner). • New members joining in the final quarter: invoiced a pro-rated amount for months remaining in the year plus next year’s dues to confirm commitment. • New members joining any other time: invoiced a monthly pro-rated amount for the remainder of the year. Planned Join Month * ---JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Join Year * ---20252026 I acknowledge the Membership & Dues policy above, including December invoicing for 2026 and the applicable pro-rating rules. Identify 3 Business References Please include the name of the business, their phone number, address, email, and what your relationship with that business is. Name of person who referred you Submit
