. Please Check All Which Apply: New Member Renewal Upgrade Update Information
.
Contact Information:
Last Name	* required
First Name	* required
Middle Initial
Nickname
E-Mail Address	* required
Home Street Address	* required
City	* required
County	* required
State	AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA PR RI SC SD TN TX UT VT VI VA WA WV WI WY
Zip Code	* required
Country	USA
Home Phone Number
Text Message Phone Number
Voice Message Phone Number
Organizational / Membership Affiliations:
.                                                                                                      List In Order Of Most Favorite		.          Affiliation Status
1.		Application in Process Current Member Former Member
2.		Application in Process Current Member Former Member
3.		Application in Process Current Member Former Member
4.		Application in Process Current Member Former Member
5.		Application in Process Current Member Former Member
Community Service / Volunteer Work:
.                                                                                                                  List In Order Of Most Favorite		.              Position
1.
2.
3.
4.
5.
Donations To Charity:
.                                                                                                 List Names Of Organizations Receiving Goods.		.                      Type of Goods
1.		Anonymous Christmas Gift(s) Appliances Automobiles Cash Clothes Electronics Food Furniture Gift Cards Lawncare Items Miscellaneous Items Yard Items Other
2.		Anonymous Christmas Gift(s) Appliances Automobiles Cash Clothes Electronics Food Furniture Gift Cards Lawncare Items Miscellaneous Items Yard Items Other
3.		Anonymous Christmas Gift(s) Appliances Automobiles Cash Clothes Electronics Food Furniture Gift Cards Lawncare Items Miscellaneous Items Yard Items Other
4.		Anonymous Christmas Gift(s) Appliances Automobiles Cash Clothes Electronics Food Furniture Gift Cards Lawncare Items Miscellaneous Items Yard Items Other
5.		Anonymous Christmas Gift(s) Appliances Automobiles Cash Clothes Electronics Food Furniture Gift Cards Lawncare Items Miscellaneous Items Yard Items Other
Hobbies And Interests:
What Do You Do In Your Spare Time?	Arcades Arts & Crafts Auto/Trade Shows Church Functions Clubbing / Partying Collecting Items Concerts/Live Shows Cooking Dancing - Performing Arts Dining Exercise / Fitness Flea Market/Garage & Yard Sales Fraternity / Sorority Activities Gambling: Bingo / Lottery / Scratch Offs Gambling: Casino Gambling: Race Track Gambling: Other Gardening Internet / Web Browsing Knit / Crochet ./ Sew / Quilt Maker Martial Arts Movies: Rent / Purchase Music: Singing Music: Playing Instrument(s) Music: CDs/MP3/I-Pod Playing Cards Playing Checkers/Chess/Dominoes Read Scrapbook Making Shopping Sports: Baseball Sports: Basketball Sports: Bowling Sports: Camping Sports: Fishing Sports: Football Sports: Golf Sports: Gymnastics Sports: Hockey Sports: Hunting Sports: Polo Sports: Racquetball Sports: Skating Sports: Soccer Sports: Swimming Sports: Tennis Sports: Volleyball Sports: Professional Games Sports: Other Socializing Theatres: Plays/Movies Traveling: Cruises Traveling: Site-Seeing Traveling: Visiting Friends & Relatives TV Watching / Cable / Satellite Video Games Wine Tasting Write Other
Do You Own Any Pets?	Yes No	.        Types Of Pets Bird(s) Cat(s) Dog(s) Farm Animal(s) Fish Guinea Pig(s) Hamster(s) Rabbit(s) Snake(s) Turtle(s) Other
Do You Own Any Plants?	Yes No	.           Location Indoor Plants Outdoor Plants Flower Garden Fruit Garden Herbs Garden Vegetable Garden Other
Religion:
What Is Your Religion Preference?	African Methodist Episcopal Apostolic Assemblies of God Baptist Buddhist Catholic Christian Christian Methodist Episcopal Church of Christ Church of God Episcopal Evangelical Hindu Interdenominational Islamic Jehovah's Witnesses Korean Lutheran Methodist Missionary Mormon Non-Denominational Pentacostal Presbyterian Seventh Day Adventist Southern Baptist United Church of Christ Other Atheist / I Don't Believe In Religion
How Many Years Have You Been Affiliated With Your Religion?	0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 Over 50
Are You An Active Member Of A Church?	Yes No
How Many Years Have You Been A Member Of Your Church?	0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 Over 50
Do You Tithe?	Yes No
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.		Yes No
Church Name
Address
City
County
State	AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA PR RI SC SD TN TX UT VT VI VA WA WV WI WY
Zip Code
Country	USA
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:
. What Do You Think Is The Biggest "Good Deed" You've Ever Done?
.  Why Did You Perform This "Good Deed"?
. What Did You Get Out Of It?
. When Did It Happen?
. How Long Did It Last?
. 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?		Yes No
Terms & Conditions:
Terms and Conditions I do, of my own free will and accord, solemnly and sincerely promise, on my sacred honor, that I will never reveal by word or deed any of the business of NAABC LLC unless lawfully authorized to do so. I promise to abide by the Constitution and Laws, and the will of the majority, honor the By Laws and Trade Rules established by NAABC LLC and Organizations affiliated with the Club and that I will use every honorable means to procure patronage for brother and sister members. I agree that I will ask for the NAABC LLC label and purchase business products and/or business services when same can be had. And, I further agree that if, at any time, it should be discovered that I have made misstatements as to my qualifications for Membership &/or Independent Contractor I shall be forever expelled from Membership and benefits in this order. I pledge myself to be obedient, orderly in any meeting, confrontation or representation, respectful in words and actions and charitable in judgement of my brother and sister members. To all of this I promise and pledge my most sacred word and honor to observe and keep, and the same to bind me, as long as I remain a Member of NAABC LLC. And, I further declare that I am not now affiliated with, and never will join or give aid, comfort or support to any organization or individual that tried, is trying or tries to disrupt NAABC LLC, its officers or any other affiliate in good standing with NAABC LLC. Being admitted to membership, I agree to be bound by the above obligation of NAABC LLC which I have read. I further agree that if it is found at any time that I have made false statement(s) of any kind on this application that my membership shall be declared void and all moneys rendered shall be forfeited.
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