Center for Family Business Membership Application

Thank you for your interest in becoming an active member in the Penn State Behrend Center for Family Business! We are excited about the what the Center can do for family businesses in the Erie region. With your participation, the Center becomes even stronger!

The information we collect will be used to better understand your business and your needs. This enables us to develop meaningful programming as well as strategically aligned peer groups. All information remains confidential and will only be reviewed by the Center’s Executive Committee. No information will be shared with a third party.

Please complete this application with your membership payment. Visa, MasterCard, and Discover credit cards are accepted.

An asterisk (*) indicates that you must complete the field in order for this form to be processed.

Membership

Options:

Currently, there is one membership option—a Traditional Membership. The fee for this membership is $500.

For new members, the membership fee is $500 and covers a 12-month period. Membership also includes all employees of the business.

Company Contact Information

Company Name (as it should appear in print) *

Primary Contact: First Name *

Primary Contact: Last Name *

Are you an alumni of Penn State University? *

Email Address (preferred) *

Phone Number (preferred) - Include area code using this format: 999-999-9999 *

Address: Line 1 *

Address: Line 2

City *

State *

Zip Code *

Other Locations, Subsidiaries, or Related Companies - List one per line

Company Website - Include http:// or https:// in the address

Company Information and Demographics

Established Year - Enter as 4 digits *

Number of Full-time Employees (approximate) *

Ownership (Check all that apply) *

Privately Held

Family Owned

Other

Annual Sales Range (approximate) *

Market Area *

Principal Owner's Name

Senior Owner's Generation

How many family members are currently working in the business? (If none, enter a zero.)

Industry *

Annual Capital Investment *

Other

What do you hope to get out of membership in the Center?

What areas of expertise or experience do you feel comforable contributing to the group?

Please share any areas of special interest or concern.

Peer Group Participation

Peer Groups are small, confidential discussion groups where members learn from each other by sharing business challenges (specific to family business or otherwise), personal issues, and any other issues that can benefit from the shared wisdom of the group. This is a safe environment that provides a powerful opportunity for business and personal growth.

The participation fee for a peer group is $200/member and covers a 12-month period. More than one person from a member company can participate in peer groups.

List the names, roles, and email addresses of those from your company who may be interested in participating in a Peer Group. List one person per line.

Please have someone contact me regarding peer group participation

Yes

Value Statement

The Behrend Center for Family Business values a culture that promotes trust, growth, continuous learning, support and an environment that improves all family and private businesses in the Erie region.

Agreement *

I have read and agree to abide by the value statement of the Penn State Behrend Center for Family Business.

Membership Payment

Traditional Membership Option

Currently, there is one membership option—a Traditional Membership. The fee for this membership is $500.

Peer Group Option

Participation fee for a Peer Group is $200/member. More than one person from a member company can participate in Peer Groups.

Payment

Visa, MasterCard, and Discover credit cards are accepted.

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Payment Method *

Credit Card

Invoice

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After you press the Submit button, here's what will happen next:

If you selected "Credit Card": You will be taken to a shopping cart to review your selections. Next, click the Pay Now button to be routed to Penn State's credit card payment site. This is the screen where you will enter your credit card information.
If you selected "Invoice": You will be taken to a shopping cart. However, please STOP at this point and do not click any buttons. The application form has been submitted and an invoice will be emailed to you.

Select one or more options:

Traditional Membership Fee [$500.00]

Peer Group Participation Fee (per participant) [$200.00]

Donation Choice

I would like to make a contribution to the Center for Family Business that will be used to provide memberships to businesses, that need the services of the center, but cannot afford the membership fee.

Donation quantity

Set your donation quantity by $1 increments (example: for $10.50, enter 10.50).

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Center for Family Business Membership Application