Membership Sign-up & Renewal

Fill out the form below to sign up for NET membership. This form should also be used for renewals.
Payment options will be displayed on the next page. Membership fees are non-refundable and non-transferable.

* Required Fields

Member Status:	New Renewal
Personal Information
* Formal First Name:
Preferred First Name (if different):
* Last Name:
* Primary E-Mail:
Secondary E-Mail :
Company:
Occupation / Title:
* Home Address:
* City, State, Zip	,
Home Phone:
Work Phone:
Birth Date:
Gender:	Male Female
Other Information
How did you hear about us?
Please specify further referral details:
Are you willing to help plan an event?	Yes Maybe No
What types of events are you willing to help out with?
* Lehigh Valley Style magazine offers a one-year subscription to NET members. Would you like to opt-in to this benefit and receive a subscription? Yes No
* Payment amount:	One Year: $50
Release and Waiver of Liability
Please read the following and type your name in the box at the bottom to note your agreement. In consideration of being allowed to participate in The Network of Young Professionals' activities and events, the undersigned, for himself/herself, his/her personal representatives, assigns, heirs and next of kin, and intending to be legally bound, agrees as follows: 1. I hereby release, waive, discharge and covenant not to sue The Network of Young Professionals, its officers, directors, employees, agents and sponsors (collectively referred to as "Releasees") from all liability to the undersigned, his/her personal representatives, assigns, heirs and next of kin for any and all loss or damage, and for any claims or demands therefore on account of injury to the person or property, or the death of the undersigned, whether caused by the negligence of Releasees, or otherwise, while the undersigned is participating in an activity or event of The Network of Young Professionals. 2. I hereby agree to indemnify and save and hold harmless the Releasees, and each of them, from any loss, liability, damage or costs that may be incurred due to the presence of the undersigned at an activity or event of The Network of Young Professionals, whether caused by the negligence of Releasees, or otherwise. 3. I hereby assume full responsibility for, and risk of, bodily injury, death or property damage due to the negligence of Releasees, or otherwise, while participating in an activity or event of The Network of Young Professionals. The undersigned expressly acknowledges and agrees that the foregoing Release and Waiver of Liability Agreement is intended to be as broad and inclusive as is permitted by Pennsylvania law, and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.
I certify that I am applying for membership of the Network of Young Professionals and I authorize the Network of Young Professionals to review and process my application. I agree that the act of inserting my name in the space below constitutes a valid electronic signature and evidences my agreements with the same effect as my ink signer signature.
Type your name here to sign electronically:

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Membership Sign-up & Renewal

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Release and Waiver of Liability