Date of Birth (Month/Day/Year) / Referred by (if applicable)
Mailing Address
City / Zip Code
Home Phone # / Cell Phone #
E-mail Address
List other community organizations/programs you are currently involved in:
I would like to join one of the following committees:
Membership
Expand XLO Membership to a minimum of 40
Schedule opportunities to learn and network
Service to CEP
Mentoring/Coaching CEP Partners and other local businesses
Hold a Workshop – “How to Market to the Senior Demographic”
Service to Residents
Expand CEP Website to Include Retirement Resources
Build a Workshop – “Welcome to Your New Community”
Service to Relocation
Retirement Requests to CEP Web, Phone & Written
Increase Outreach Calls or Emails to persons interested in relocation to O/MC
Promote our community as a premier place to retire
*Please check one:
¨ I would like to become a member ($75)
¨ My spouse would like to become a member with me ($24)
¨ I am a renewing member ($75)
¨ I am a CEP partner and the Sole Proprietor of my business and am using my Complimentary benefit
¨ I am using CEP Credit or Complimentary based on my company’s investment level
o Credit
o Complementary
Method of Payment: (please check one)-Unless Otherwise Indicated Above
¨ Check #______enclosed (payable to: Chamber & Economic Partnership)
¨ Visa ¨ MasterCard ¨ Discover ¨ AMEX
Card Number #:
Expiration Date: Verification Code (on back of card):
Name on card:
Signature:
Thank you for your support of the Experienced Leaders Ocala Group
*All CEP partners, with an interest in the Senior Demographic, are welcome to become a member of XLO
Please Return this Application to:
310 SE Third Street | Ocala, FL 34471
Or fax to 352.629.7651
Staff liaison: Bart Rowland, Director of Business Services and Staff Liaison to XLO
Email: | PH: 352.629.8051
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