Applicant’s Full Name

Name you would like to be called

Birthday (Month/Day/Year)

Spouse Name (if applicable)

Home Address

City

State

Zip Code

Business Name


Primary Business Services


Length of time in business


Position / Title


Check all that apply
OwnerExecutive OfficerPart - OwnerNone of these apply

(Executive Officer is “a person holding a senior management position in an Organization”.)

Business Address

City

State

Zip Code

Business Phone

Business Fax

Business Website

Business Email

The Tallahassee “100” Club bylaws and attendance requirements are located on our website.

Have you read the Tallahassee 100 Club bylaws and agree to abide by them?
YesNo

Do you acknowledge the Tallahassee 100 Club attendance requirements?
YesNo

Have you visited a lunch or dinner meeting of the Tallahassee 100 Club?
YesNo

What other business groups are you involved in?

(Your Sponsor Cannot be a reference. Do not use relatives.)

1.) Personal Reference Contact Name

Phone Number

Email Address

2.) Business Reference Contact Name

Phone Number

Email Address

After submitting this form, you will be directed to our secure payment portal to pay the non-refundable application fee using any major credit card.

Alternatively, you can select the option to mail your payment via check to the following address:

Tallahassee 100 Club
P.O. Box 5989
Tallahassee, FL 32314

Please note that a portion of this fee may be used to conduct a criminal background check, civil background check, and/or credit check. By signing below, you authorize us to perform these checks as part of the application process.

Annual Club dues will be pro-rated based on the remaining months in the year, starting from the month of Club approval. Applicant must first be approved by the Club’s Board of Directors, then by the Membership at large. Fully approved applicants will be invited to join. We will bill you for the appropriate dues amount. You must be sworn in and take the “Membership Pledge” before you will be entitled to attend Club luncheons, dinners, and social events along with your guest.

Please be advised, it may take up to 60 (sixty) days to process this application.

Note: Applications must be fully completed before vetting can begin.

Applicant’s Sponsor

Applicant’s Signature

Date

Application Fee*
$60