Behind The Moon, Inc. Online Application
First Year Membership $125

First Name:
Last Name:
Your Date of Birth: (month/day)
Who told you about our Membership Program?
 

COMPANY INFORMATION FOR LISTING
Company Name:
Tagline (max 90 char):
Street/Mailing Address:
City:   State:     Zip:
Business Phone:
Alternate Phone:
Email Address:
Website:
What is your Member-To-Member discount (max 90 char):
 
Business Category:
First Position within the above Category ($60)?
Additional Business Category ($36 select below):
2nd Business Category:

LIST A SECOND COMPANY ON MEMBER PAGE ($72)
Company Name:
Tagline (max 90 char):
Street Address:
City:   State:     Zip:
Business Phone:
Alternate Phone:
Email Address:
Website:
What is your Member-To-Member discount (max 90 char):
 
Business Category:
within the above Category ($60)?
Additional Business Category ($36 select below):
2nd Business Category:
Comment:

*All fees apply to the first year of membership.
CASH ~ CHECK ~ PAYPAL ACCEPTED

I am submitting this application for the Behind The Moon® Membership Program.  I understand that submitting my application does not guarantee acceptance of Membership and that fees are due in full before Membership shall be activated.  Once activated, my Membership shall be good for 12 consecutive months.  I understand there may be other Members from my industry and/or company enrolled in the Behind The Moon® Membership Program.  I further understand my membership renewal will be billed annually, in the month my Membership is set to expire.  I am eligible for the discounted renewal rate only when my Membership is renewed before the end of the month is it scheduled to expire (the 12th month).  If I do not pay for the next year Membership before the end of 12th month of my existing Membership, it will be presumed I wish to cancel my Membership and I will no longer be eligible for exclusive Member benefits or the discounted Membership Renewal Fee.  To cancel prior to the end of my Membership, I can do so at anytime in writing and once submitted, all Member benefits will cease and the remainder of my Membership is non-refundable under any circumstances.  I understand Membership cannot be transferred to another party. Finally, I understand that to remain a Member in good standing, all Membership dues must remain current and paid in full.

 
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