Kanafom Business Membership Application

application INFORMATION

Name: / Date:
Date of birth: / Phone: / Email address:
Current address:
City: / State: / ZIP Code:
Are you a U.S citizen: / If no, are you authorized to work in the U.S:

Business/Ministry Information

Business/Ministry Name:
Business/MinistryAddress: / How long at this address:
Phone: / E-mail: / Fax:
City: / State: / ZIP Code:
Position: / Website:
Are you a startup business/ministry or established: / If established, for how long:
If a startup, are you currently providing services? / If yes, how long have you been providing these services:
If not, provide the estimated date you would like to start:

Emergency Contact

Name of a relative not residing with you:
Address: / Phone:
City: / State: / ZIP Code:
Relationship:

Spouse Information if joint membership

Name:
Date of birth: / Anniversary date: / Phone:
Employer address: / How long?
Phone: / E-mail: / Fax:
City: / State: / ZIP Code:

References

Name: / Address: / Phone:

Children

Name: / Age: / Name: / Age:
Name: / Age: / Name: / Age:
Please provide a brief description of your organization and the services you offer. Also provide anupdated resumewith your application along with any additional documentation such as business cards, brochures, etc.:
Include what your expectations are from KABN and what you desire to get from joining.

Membership Commitment

[ ] Covenant Member Requirements:

5 year commitment to KABN.
Sow seed through 10% tithe or agreed amount monthly from business/ministry.
Submit monthly updates regarding your business progress/changes monthly or as required.
Offer covenant member discounts.
100% accountability and commitment to your success and KABN!

BENEFITS AS A CONVENANT MEMBER:

2 Complimentary COACHING & CONSULTING SESSION per month

EMPOWERMENT SESSIONS

Free marketing & advertising on our website
Unlimited e-access to coaches and staff
Discounts offered with other COVENANT members
Use of brand for marketing and networking
Laser calls and point corrections as needed
A team of committed professionals to your success and agreed upon objectives

Your Investment:

Initial Registration/Membership Fee: $250 (waived for 2013) (One-time fee)
Monthly Fee: $25 minimal contribution (unless the amount of your titles exceeds the monthly fee)

Signature Part 1

I understand that there is an initial membership fee due upon completion of this application. Your annual renewal membership fee is due January 1st of each year. By submitting this application and membership fee I understand that I will be offered support, training, & covering according to the level of membership I choose. I also understand and agree to abide by the requirements and commitment according to the membership level agreed upon.
Signature of Applicant: / Date:

Signature Part 2

I authorize the verification of the information provided on this form as to my membership. I have received a copy of this application and understand the terms of condition. I release all rights to any photos takenhas my permission to use, publish a photograph or likeness of me or my company in publications, web pages, presentation and promotional materials produced, used by and representing KABN. I hereby waive any right that I may have to inspect or approve the finished product or products that may be used in connection therewith or the use to which it may be applied. I hereby release and agree to save harmless KABN and all persons acting under its permission or authority from any liability by virtue of any alteration or use in composite form, whether intentional or otherwise, that may occur or be produced in the taking of said picture or in any subsequent processing thereof, as well as any publication thereof, including without limitation any claims for libel or invasion
of privacy.
Signature of Applicant: / Date:
KABN Representative: / Reviewed Date: