Entrepreneurs of Tulsa

Membership Form

Please take a moment to complete this form for the membership directory.

Print this form and mail with your payment to:

                            Entrepreneurs of Tulsa, 9226 S. College Ct, Tulsa, OK 74137

Choose a Membership Category:

_____ Individual - $100, non-transferable:

        Name: __________________________________Company: ______________________________         

_____ Corporate - $200, transferable among company employees:

Primary Name: _______________________________________ Title: ______________________

        Company: ______________________________________________________________________   

_____ Sponsor - $600.00+, contact Board members for additional support opportunities.

        Name: ___________________________________Company: _____________________________

.

General Information:

Mailing Address: _____________________________________________________________________

City: ____________________________________________ State: _________ Zip Code: ___________

Phone: ___________________________________ Fax: ______________________________

Email Address: ______________________________________________________________________

Web Site Address: ___________________________________________________________________

Please check the category and sub-categories that apply to you or your company from the following:

_____ Entrepreneur, An individual or organization that is seeking mentoring, finance, venture/angel funding, service providers and other resources to start, grow or improve their business.

           _____ Technology Firm  _____ Software Provider _____ Bio-medical/Health _____Retail

_____ Manufacturing Company   _____ Other________________________________________

_____  Service Provider, A company that provides services to other businesses.

           _____ Accounting  _____ Legal _____ Marketing _____ Consulting _____ Technology

           _____ Financial _____ Non-Profit Organization _____Communication _____Training

           Other_______________________________________________________________________ 

_____ Investor/Finance, An organization that provides funding to start-up and high-growth businesses.

______Commercial Banking ______Angel Investment Group ______Venture Capital Firm

_____ Educational _____ College/University _____ Vocational/Technology Training

_____ Government/Economic Development Organization  _______ Department of Commerce 

______ Economic Development  _______Chamber of Commerce   _______ Other__________

Please list any affiliations you may have: ________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Mail / Fax to: H. Frank Wilcox, Entrepreneurs of Tulsa, 9226 S. College Ct, Tulsa, OK 74137

Phone (918) 298-9226    Fax (918) 298-9235