:: LeanJax - STRENGTH IN NUMBERS ::

Membership Application

Membership Fees
Size of Company Number of Employees	Yearly Fee	Initiation Fee	First Year Fee

1 - 15 Employees	$1,000	$500	$ 1,500
16 - 50 Employees	$2,000	$500	$2,500
51 - 150 Employees	$4,000	$1,000	$5,000
151 - 500 Employees	$6,000	$2,000	$8,000
500 + Employees	$8,000	$2,000	$10,000

Company Name:
Site Address:
Mailing Address:
City:
State:
Zip Code:
Primary Delegate:
Title:
Phone:
Fax:
Email Address:

Alternate Delegate:
Title:
Phone:
Fax:
Email Address:
Company Description:
Referring Member Name:
Company:

AGREEMENT: When accepted into membership, I agree to abide by the Bylaws and Rules of the Consortium, including financial commitments.
Payment: Visa, Master Card, purchase order, check or invoice
To make payment accommodations, please contact Faith at (904) 281-9026.

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