MEMBERSHIP APPLICATION

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Please Check All Which Apply:

New Member
Renewal
Upgrade
Update Information

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Contact Information:

Last Name
 * required
First Name
 * required
Middle Initial
Nickname
E-Mail Address
 * required
Home Street Address
 * required
City
 * required
County
 * required
State
Zip Code
 * required
Country
Home Phone Number
Text Message Phone Number

Voice Message Phone Number

Organizational / Membership Affiliations:

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                                                                                                     List In Order Of Most Favorite

        Affiliation Status

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2.

3.

4.

5.

Community Service / Volunteer Work:

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                                                                                                                 List In Order Of Most Favorite

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            Position

1.

2.

3.

4.

5.

Donations To Charity:

                                                                                               List Names Of Organizations Receiving Goods.

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                    Type of Goods

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2.

3.

4.

5.

Hobbies And Interests:

   

What Do You Do In Your Spare Time?

 

Do You Own Any Pets?

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      Types Of Pets

Do You Own Any Plants?

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          Location

Religion:

   

What Is Your Religion Preference?

 

How Many Years Have You Been Affiliated With Your Religion?

 

Are You An Active Member Of A Church?

 

How Many Years Have You Been A Member Of Your Church?

 

Do You Tithe?

 

Do You Authorize 10% Of All Commissions Earned From NAABC LLC To Be Payable To A Church?

If no church is specified below, NAABC LLC will delegate your 10% randomly to a church of its choice.

Church Name

Address

City

County

State

Zip Code

Country

Website Address

Office Phone Number

Fax Phone Number

Alternate Phone Number

Pastor Name

Pastor Title

Pastor's E-Mail Address

Pastor's Cellular Phone Number

Church Secretary Name

Church Secretary's E-Mail Address

Office Hours

Hours of Worship

Tell Us More About Yourself:

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What Do You Think Is The Biggest "Good Deed" You've Ever Done?
Why Did You Perform This "Good Deed"?
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What Did You Get Out Of It?
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When Did It Happen?
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How Long Did It Last?
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What Is The Most Recent "Good Deed" You've Done (That You'd Like To Share With Us?
Why Did You Perform This "Good Deed"?
What Did You Get Out Of It?
When Did It Happen?
How Long Did It Last?
What Do You Think Qualifies You As A Prime Candidate For Joining Our Benevolence Club?
What Would You Like To See Happen Through Your Membership In Our Benevolence Club?
Would You Like To Share Anything Else With Us?

Terms & Conditions:

I have read and agree to abide by the Terms and Conditions as outlined above.

Signature:

By signing this application, either electronically or manually, I understand and agree to adhere to the above.  I have provided all truthful information.  I understand my application is subject to denial or rejection at any time if the above information is deceitful in any manner.  I also understand if my application is approved I will be solely operating as an Independent Contractor or Authorized NAABC LLC Dealer in business for myself, utilizing NAABC LLC as my sole source of supply for its products &/or services to its members &/or potential members.

Signature

 * required

Date Signed (mm/dd/yyyy)

 * required
     

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