Affiliate Application

(2023)

Name(Required)

First Last

Organization / Firm(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone(Required)

Email(Required)

Website(Required)

Nature of Business(Required)

Years in Business(Required)

(COUNTIES)

County 1

County 2

County 3

County 4

Target Market(Required)

Primary Interest(Required)

Attestation(Required)

I have read and understand the CDI Business Affiliation flyer, including its conditions

I understand that use of contact lists outside the terms of this Agreement is prohibited

I understand that communication with CDI Fellows is subject to prior approval by CDI

I understand that any Practice Group presentations are primarily educational in nature

I agree to pay the 1-year Business Affiliate fee of $225

I understand that my Business Affiliation is subject to approval by CDI

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