Consortium Ambassadors Membership Form

Yes...... I Want to Join the Consortium for Entrepreneurship Education

(Copy this form to a Word file, fill it in, and e-mail it to us at cashmore@entre-ed.org or by fax to 419-791-8922)

The Ambassadors Membership for teachers/instructors is $100 which brings:

• Monthly email newsletters from the Consortium, identifying opportunities and success stories from other programs.
• Opportunities to share your program ideas with others through the email, newsletter, and website
• A special Consortium logo that Ambassadors may use on their publications and website.
• A 20% discount on registration for the Entrepreneurship FORUM for the Ambassador and a colleague ($79 discount per person at the current rate of $395)

---

I am a teacher or instructor and wish to join the Consortium. My contact information is below. (Choose from the following:)

1. My check for $100 membership fee _____will be mailed separately,
   _______or my check for $100 is enclosed.
2. _______Please charge my credit card for $100 membership fee
   
   • Number:

     ---

     
     
   • Expiration Date

     ---

     
     
   • Billing Name, Address

     ---

     
     

     ---

     
     

     ---

     
     
3. Please bill my organization for $100. Make invoice to the attention of:
   

---

---

---

CONTACT INFORMATION:

Name:

Title:

Organization:

Address:

City:

State:

Zip code:

Phone:

E-Mail:

Web Site:

---

E-mail us at cashmore@entre-ed.org

Or mail this form to:

Dr. Cathy Ashmore, Executive Director,
The Consortium for Entrepreneurship Education
1601 West Fifth Avenue, #199
Columbus, OH 43212
614-486-6538, fax 419-791-8922

---

Why | What | Where | How | Who