Membership Application

Applying for:
Individual Resident Membership ($35)*Business Membership ($75)*Platinum Membership ($150)*

Organization/Business Name: (required)

Address: (required)

Email Address: (required)

Phone Number: (required)

Primary Representative(s)/Owners(s): (required)

Additional Representative(s):

Preferred Contact Person(s): (required)

Preferred method(s) of contact? (required)
EmailPhoneMail

How long has your organization/business been in Lakewood?

Briefly describe the general nature of your business: (required)

Are you interested in Taskforce Membership?
YesNo

Are you interested in joining a Taskforce Committee?
YesNo

I agree to uphold the WE Alliance Membership Pledge.

I acknowledge that my Membership Application is incomplete until I remit payment.
Checks should be made payable to LakewoodAlive with "WE Lakewood" in the memo. Mail checks to LakewoodAlive, 14701 Detroit Avenue, #LL10, Lakewood, OH 44107