Belden Club Southern California Application

Are you an existing Belden Club Member interested in referring a new member? Please let us know more about the prospect.

I propose that an invitation for membership in The Belden Club Southern California be issued to:
Name of Nominee
Email
Telephone
Residence Address
City
State/Zip
Business Address
City
State/Zip
Send Mail to:
Present Occupation
Name of Firm
Years Employed
Nature of Business
Occupation past 10 years (show position and title, please list seperately)
Place of Birth
Birthday (MM/DD/YYYY)
Give names of clubs and fraternal organizations of which Nominee is now a member
What business connections do you have, if any, with the Nominee, his/ her employer or associate?
To what extent is the Nominee possessed of musical, literary, oratorical, artistic or athletic talents?
Colleges or Universities attended - Degrees (please list seperately)

Proposer:
Please give us your opinion as to why you feel the Nominee would make a good member to The Belden Club:
Nominee has been known to Proposer:	years
To the best of my knowledge and belief, the proposed Nominee is financially able to meet his/her responsibilities as a member of the Belden Club. The Nominee has been advised that if invited to become a member, the Nominee will be responsible for an annual membership fee, currently based at $150.00 per year.	check to confirm
Proposer Name:
Business Phone:

New Members