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Emerging Leader Program Membership Application
Emerging Leader Program Membership Application
Welcome to Vistage, the leading business advisory and executive coaching organization serving more than 22,000 members worldwide.
We are excited to have you as a member of the Emerging Leader Program and look forward to helping you master core leadership competencies that will prepare you for greater leadership roles.
Once we’ve approved your application, you will have full access to all Vistage membership benefits, including an exclusive online portal to our international community and powerful networking opportunities through our 15 industry and interest Networks.
Toll free: 800.274.2367Email: [email protected]
Payment card industry notice:• Do not email completed applications with your payment
information.• Proper application submission methods:
• Mail by trackable courier (certified mail, UPS, FedEx, etc.)• Secure fax: 858.509.5801• Email, with payment information completely obscured.
Call Membership to provide payment information.
Membership commitments Upon acceptance as a member, You agree to:
a. Begin membership in the month indicated on the application;
b. Undertake best efforts to participate in scheduled Vistage group meetings;
c. Share experiences, challenges, skills and knowledge with fellow members;
d. Maintain strict confidentiality of all Vistage Group discussions;
e. Immediately disclose any potential conflict of interest issues to your Vistage Group; and
f. Complete a personal profile on My Vistage and maintain up-to-date account information.
See complete terms and conditions on the following pages.
Your satisfaction is our commitmentContact us with any questions you may have regarding your Vistage experience. Client Services is committed to answering your questions within one business day, Monday through Friday, 7:00 a.m. to 5:00 p.m. PT.
If you have questions or wish to discuss how we can enhance your member experience, please contact Client Services:
© 2018 Vistage Worldwide, Inc. and TEC are registered trademarks of Vistage Worldwide, Inc. All rights reserved. www.vistage.com
• Shred or delete any physical and electroniccopies of completed application. Keep onlythe contact information without paymentinformation for your records.
Membership Application & AgreementMember information Please complete the contact information below. All fields required.
Name (prefix, first, middle initial, last, suffix) Job title
Business phone Cell phone
Name (as you would like it to appear for member recognition) Email (primary)
Gender: n Male n Female Date of birth
Sponsoring Company information
Company name Business description
Company address Important: List a physical address for both USPS and FedEx delivery
City State Zip
Billing contact Telephone Billing contact email
Company billing address (if different from above)
Membership dues: • 1st year dues $5,100 (due at signing)• 2nd year dues $5,100 (due prior to beginning of 2nd year)
Method for initial payment
(if different from recurring billing option): n Electronic funds transfer (EFT) payment n Credit card payment n Check (Make check payable to Vistage Worldwide, Inc.)
Your signature below indicates acceptance of commitments and the Membership Terms and Conditions outlined in this membership application and agreement. Your signature further indicates you are acting in your capacity both as an individual AND as a representative of the Sponsoring Company, thus binding the Sponsoring Company to this agreement.
XAuthorized signature (required) Date
Title (required)
Print name
Please choose one of the following three billing options for payment of dues:
1. Recurring electronic funds transfer*
n Annual
ABA/Routing number:
Bank account number:
________________________________________________________________________________________ X________________________________________________________________________________
Bank name Authorized signature (required) Date
2. Recurring credit card*
n Annual
Card Type: n Visa n MasterCard n American Express
Expiration date:______ / _______
Cardholder’s name:_____________________________________________________________________
3. Invoicing n Annual
Cancellation Policy: Members are required to provide a written notice of cancellation of membership to Vistage. Annual prepayments are non-refundable.
*Electronic funds transfer/credit card authorization: I hereby authorizeVistage to initiate charges to the above stated credit card or bank account (a)for the amount due at signing and (b) if a recurring billing option is selected. Inthe event of a declined credit card or insufficient funds, Vistage will continue tosubmit a request for payment until approval for payment is received.
xInitial here
Vistage use only
Vistage member ID
Be sure that the Chair and Group information is filled out completely. Submit Membership Application & Agreement to: Vistage Worldwide, Inc., 4840 Eastgate Mall, San Diego, CA 92121U.S.: 800.274.2367 Fax: 858.509.5801 Email: [email protected]
Chair and group information (to be filled in by Chair)
____________________________________________________________________________Chair name Applicant’s group # Start month (mm/yyyy)
________________________________________CEO sponsor name
________________________________________CEO sponsor group #
Vistage Worldwide, Inc. Membership Terms and Conditions agreement (Emerging Leader Program)
1. Effect of agreement: This Membership Terms and Conditions Agreement (“Agreement”) is entered into on behalf of the individual named on the Membership Application AND the Sponsoring Company listed on the application (if any) (collectively referred to herein as “You”) and Vistage Worldwide, Inc. (“Vistage”). Both the individual and the Sponsoring Company listed on the Membership Application are responsible for the payment of dues and Vistage shall be entitled to collect the full amount owed from either the individual or the Sponsoring Company. By signing this application, the individual confirms that s/he is authorized to bind the listed Sponsoring Company to this financial responsibility.
2. Acceptance: Submission of a Membership Application by You does not guarantee acceptance as a Vistage member. You will be notified of your application status after submission.
3. Membership commitments: Upon acceptance as a member, You agree to:
a. Begin membership in the month indicated on the application;
b. Undertake best efforts to participate in scheduled Vistage Group meetings;
c. Share experiences, challenges, skills and knowledge with fellow members;
d. Maintain strict confidentiality of all Vistage Group discussions;
e. Immediately disclose any potential conflict of interest issues to Your Vistage Group; and
f. Complete a personal profile on My Vistage and maintain up-to-date account information.
4. Vistage materials: As a member, You will be given exposure to and other access to utilize Vistage’s methodologies and materials along with other confidential information and intellectual property (“Materials”). You understand and agree that Vistage owns all rights, title and interest, including all intellectual property rights for these Materials.
5. Payment: Initial payment is due with the submission of application. If you’ve selected credit card or EFT as your payment method, your account will be charged following acceptance of your membership. If you’ve selected check as your payment method, you must include a check with the application. The check will only be deposited upon acceptance of your membership. Application will not be processed unless initial payment is received. You will otherwise be responsible forthe payment of member dues in advance of the period for which dues are payable. Refunds will not be provided once the program has begun. If You have elected automatic payment, dues will be automatically charged to Your selected method of payment until Your membership is terminated.
6. Additional terms: You agree to the Vistage Terms of Use located at vistage.com/terms, and Privacy Policy locatedat vistage.com/privacy, as updated from time to time.
7. Scope of services: The advice, services and opinions provided as part of the Vistage experience are intended to expand thinking and inspire further exploration but are not to be considered a substitute for professional financial, legal, psychological, medical or other professional advice. Even where Vistage Group members or Chairs may be credentialed as professional advisors, an individual relationship with such advisors has not been created and should not be relied upon as professional advice. The Vistage experience is provided “as is” with no warranty of any kind. There is no obligation for members to engage in business transactions with Vistage members, Chairs or other Vistage affiliates. Should You elect to engage in such business transactions, You agree that Vistage bears no responsibility or liability for any losses arising therefrom.
8. Limitation of liability: To the fullest extent permitted by law, the maximum liability of either party shall not exceed the amount paid by You to Vistage for the 12-month period preceding the occurrence giving rise to such liability. In no event shall either party be liable for consequential, incidental, indirect, punitive or special damages, or loss of profits, data, business or goodwill, regardless of whether such liability is based on breach of contract, tort, strict liability, breach of warranties, failure of essential purpose orotherwise.
9. Binding arbitration: To the fullest extent permitted by law, any controversy or claim arising out of or relating to this Agreement, or the breach thereof, shall be determined by arbitration before a single arbitrator and administered by JAMS in accordance with its Rules (jamsadr.com). You and Vistage agree to bring any dispute to arbitration on an individual basis only, and not on a class or collective basis on behalf of anyone else. Judgment on the award rendered by the arbitrator(s) may be entered in any court having jurisdiction thereof.
10. General: This Agreement may not be modified unless such modifications are specifically approved in writing by a Vistage Senior Vice President or above and signed by both parties. If any term of this Agreement is deemed unenforceable, the legality and enforceability of the remaining provisions shall not be affected or impaired. This Agreement will be governed by the laws of the State of California, without regard to conflicts of laws rules.
MF-V1-EL-6-6-2018
“Now, let’s get down to work.” Bob Nourse
Founder
Our valuesTrust Caring Challenge Growth
Our missionImproving the effectiveness and enhancing
the lives of CEOs and Key Executives.
Our global reachArgentina
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© 2018 Vistage Worldwide, Inc. All rights reserved. 18_221_5033 EL
Vistage Worldwide, Inc.
4840 Eastgate Mall | San Diego, CA 92121
Ph 800.274.2367
Intl +1.858.523.6800
Fax 858.523.6802
www.vistage.com
