Membership Form

Membership Application

To apply for membership please complete all questions.
Title*
Select Title
Name*

First NameLast Name
Date of Birth*

DayMonthYear
Date
Nationality*
E-mail*
Company*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Cellular Number*

Area CodePhone Number
Work Number*

Area CodePhone Number
Website
This is a

Home AddressBusiness Address
I would like to apply for the following grade*

Corporate Platinum Member $20,000Corporate Gold Member $5,000Corporate Silver Member $2,000Corporate Bronze Member $500Collaborator $250Regular Member $50Student Member $10Affiliated Member (Non Lebanese) $50
Kindly fill out the applicable:
Educational record*
College or University*
Graduate study*
Professional registrations
Other memberships
How did you hear about LebanonGBC?*
Kindly print this application form, sign it and attach it with a copy of your Identification Card & CV and e-mail them to:

info@lebanon-gbc.org

For Student Members, a copy of the University ID is needed with the expected graduation date.

Cash, Checks, or Bank Transfers must be payable to LGBC in US dollars or Lebanese Pounds.

Membership Application