Corporate Gold Membership Application – Communities of Wellbeing

COWB Corporate Gold Membership Application

Submission of this form indicates that your organization shares our purposes and vision for Wellbeing in our community, that you are prepared to abide by the rules of the association and understand that the annual Corporate Gold membership fee is $500.

Organization Name*
Organization Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Contact Email*

Primary contact email for this membership
Organization Logo
Accepted file types: jpg, png, Max. file size: 1 MB.
Upload a logo file if you wish us to display it on our membership list and use in acknowledgements. Must be a jpg or png file
Number of Representatives*
Please enter a number from 1 to 6.
Number of nominated representatives for your organization
First Name*
First Last
Name of first representative
First Mobile*
Mobile phone number for 1st Representative
First Email Address*

email address for 1st representative
Second Name*
First Last
Name of 2nd representative
Second Mobile*
Mobile phone number for 2nd Representative
Second Email Address*

email address for 2nd representative
Third Name*
First Last
Name of 3rd representative
Third Mobile*
Mobile phone number for 3rd Representative
Third Email Address*

email address for 3rd representative
Fourth Name*
First Last
Name of 4th representative
Fourth Mobile*
Mobile phone number for 4th Representative
Fourth Email Address*

email address for 4th representative
Fifth Name*
First Last
Name of 5th representative
Fifth Mobile*
Mobile phone number for 5th Representative
Fifth Email Address*

email address for 5th representative
Sixth Name*
First Last
Name of 6th representative
Sixth Mobile*
Mobile phone number for 6th Representative
Sixth Email Address*

email address for 6th representative
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COWB Corporate Gold Membership Application

Are You a Spammer? Of Course You're Not.