Prospectors Association

Application for Membership

Applicants to Prospectors Association must be an owner, partner, officer or other type of executive with policy making authority. You must have a sponsoring member to apply.

The fee for application submission is $75.

Make payable to Prospectors Association and mail to:

Prospectors Association
c/o Steve Dufaud
2342 E. Platte Ave.
Colorado Springs, CO 80909

 Business Information

Your name:
Company name:
Name of sponsoring member:
Category for which you are applying:

(i.e. residential electrician, veterinarian, etc...)

E-mail:

If accepted, will this membership belong to the company or you? Company Individual

Are you an owner, partner or other type of executive with policy making authority:

Yes No

Job title:
Years with this business:
Business address:
City:
State:
Zip:
Years company has been in business:
Number of employees:
Phone:
Fax:
Home office phone:
Branch:
If branch, location of main office:
Type of business:  
  Manufacturer Yes No
  Distributor Yes No
  Sales Yes No
     
Deals with:  
  Consumer Yes No
  Retailer Yes No
  Wholesaler Yes No
   

Are you aware of any business credit problems? Yes No

If you are aware of credit problems please list:

List any other professional societies, clubs or service organizations to which you belong:

 

Employment Record and Professional Experience

Begin with current position and include self employment if any.

Name of employing firm:

Address of employing firm:

From mo/yr:

To Mo/yr:

Position/Job Description:



Name of employing firm:

Address of employing firm:

From Mo/yr:

To Mo/yr:

Position/Job Description:



Name of employing firm:

Address of employing firm:

From Mo/yr:

To Mo/yr:

Position/Job Description:

 

Please give a brief description of the business being proposed; the applicant's status with the company; and why you feel the proposed would make a good Prospector:

 

References

Please list three with complete address and phone number.

Name:

Address:

Phone number:

   

Name:

Address:

Phone number:

   

Name:

Address:

Phone number:

 

Personal Information

Spouse:

Residence address:

City:

State:

Zip:

Years above:

Previous address:

City:

State:

Zip:

Home phone:

 

We recommend printing the application before clicking on submit.

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