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Personal Details:
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Name:
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* Required
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Business Name:
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* Required
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Bizlinx Region:
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Bizlinx Board:
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* Required
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Board Position:
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* Required
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______________________________________________________________________________________
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Address 1:
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* Required
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Address 2:
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* Required
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Address 3:
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County
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* Required
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Postcode:
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* Required
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Country:
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Phone:
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Business:
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* Required
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Mobile:
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Fax:
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Home:
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eMail:
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* Required
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Website:
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Introduced By:
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Board Development Manager:
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Advertising or Promotion
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Web Site
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Member/ Other
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If Member/ Other Please State:
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______________________________________________________________________________________
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Please describe the products and/or services offered by your business:
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* Required
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Time in your current business (years):
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* Required
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Number of employees:
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* Required
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Industry Sector:
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Have you been, or are you currently a member of any business referral organisation?
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Details:
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______________________________________________________________________________________
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Please list the 2 most important benefits you would like to gain from joining the Board:
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Please supply the names and telephone numbers of anyone you know would benefit by joining a Board:
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Please Tick Your Preferred Payment Option:
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12 Month Membership £995 + £174.12 (VAT) Total £1,169.12
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Or
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4 x 4 Quarterly Payments (4x) £325 + (4x) £56.87 (VAT) Total (4x) £381.87
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______________________________________________________________________________________
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Please Tick Your Preferred Payment Method:
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Cheque (Payable to “Bizlinx UK & Ireland Ltd”) for full payment of my membership fees…
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Or
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Please debit my Credit Card for the full amount of my application and membership fee as shown on standing order form
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Or
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Quarterly Payments by Standing Order for the full amount of my application and membership fees. Any outstanding fees become immediately due should I cancel my membership at any time for any reason…
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Your Commitment to the Rules of Your Bizlinx Board
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I hereby make application to join the Bizlinx Board indicated above, and have enclosed my cheque / authorised credit card payment of my membership fees, subject to acceptance of my application. I acknowledge that I have read and agree to abide by the rules of Bizlinx as stated on the reverse of this application, and furthermore understand that my failure to do so will result in the cancellation of my membership.
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In signing this application, I also acknowledge that Bizlinx in no way endorses the performance, capabilities or professional expertise of any of it’s members, and accepts no liability in relation to any business conducted or referred between members. I understand that should I choose to do business with, or refer a fellow member, I do so solely of my own choice, and at my own risk.
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I agree to these terms
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