Government Membership Application

The undersigned organization/individual hereby applies for membership in the Cheyenne-Laramie County Corporation for Economic Development, subject to the by-laws of the Corporation, for the calendar year specified.

Governmental Department or Division Membership Dues are a minimum of $200 annually, per Department or Division in the name of the Department Director or Division Head, but may pay more to further support local economic development efforts.

Please fill out one application per Division or Department Head

Those fields in red are required fields

Date: 09/09/2010

Organization Name:

Mailing Address
Street or P.O. Box
City:
State:
Zip Code:
Website:

We hereby designate until further notice that our contact person for all matters relating to Cheyenne LEADS will be: (In the case of a total membership contribution of $10,000 or more, we also designate this person to serve on the Board of Directors on our behalf.)
Name:
Title:
Phone:
Fax:
E-Mail:
Total Membership Amount:
Membership payment Schedule preferred:In Full/Annually
Semi-Annual
Quarterly