Registration Form

By submitting this form, applicants acknowledge that they have read and agree to abide by Leads Group program guidelines. Please note that applications will be taken on a first-come, first-served basis and that only one member shall be accepted in each business category.

For additional details, or to make payment via credit card, please call (360) 426-2021.


Name: *
Business/organization: *
Address: *
City, State Zip: *
Business phone: *
Alternate phone:
email address: *
Category (please select one): *
Describe your business or occupation (tell us about your product/services): *
1. *
 I understand that my attendance and punctuality are extremely important. If I cannot attend, I will notify the Group moderator.
2. *
 I understand that I may be dropped from the group if I miss four meetings in a row or four meetings in a quarter.
3. *
 I understand that the main purpose of the Leads Group is the mutual exchange of qualified leads and that I must meet the required minimums, as outline in the program guidelines, to maintain membership in this group.