Innovation

CLSA Membership Fellow Application

The CLSA Fellows program is designed to nurture and grow new and incubator companies in the Northern California region. The program provides a significant reduction in member dues ($200/year) for qualifying early-stage companies, allowing them full access to the complete CLSA portfolio of benefits, as well as discounts to best practice seminars, conferences, and other networking events.

Step 1 of 3

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Primary Contact Information
Primary Contact Name*
First Last
Primary Contact Title*
Primary Contact Phone*
Primary Contact Email*
Company Contacts (complete all that apply)
CEO/President
Name
First Last
Title
Phone
Email
CFO
Name
First Last
Title
Phone
Email
CSO/CMO
Name
First Last
Title
Phone
Email
Business Development
Name
First Last
Title
Phone
Email
General Counsel
Name
First Last
Title
Phone
Email
Human Resources
Name
First Last
Title
Phone
Email

Payment Information
- CLSA Membership will begin after full payment is received and is active for 12 months.
- CLSA dues related to advocacy/lobbying activities is estimated at 25% for the 2016 calendar year
- CLSA Federal Tax ID # 47-3226523
Payment Method*
- Bill Me
Name*
First Last
Email*
Phone*
Bill Address (if different than organization address)
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
We are working to protect our customers from malicous hackers. At this time, we are not accepting credit card information online. We will follow up with an invoice.
Total
$0.00
Post Custom Field
Number

ADVOCATE. CONNECT. INNOVATE.

Innovation

CLSA Membership Fellow Application

Step 1 of 3

Corporate Information

Additional Corporate Information

Primary Contact Information

Company Contacts (complete all that apply)

CEO/President

CFO

CSO/CMO

Business Development

General Counsel

Human Resources

Payment Information