Professional Information

Full Name

Professional Title

Email Address

Phone Number

Company/Practice Information

Company/Practice Name

Website URL

Years in Business/Practice

Primary Service Location

Please specify your service area:

Professional Services

Primary Service Category (select one)

If Other, please specify:

Briefly describe your services and how they specifically benefit Baby Boomer business owners:

Qualifications & Experience

Professional Credentials/Certifications

Experience working with Baby Boomer business owners:

Please share a brief case study or success story of how you've helped a Baby Boomer business owner:

Network Participation

How do you plan to contribute to the Golden Life Business Alliance? (Select all that apply)

Providing services to network clients

Referring business owners to the network

Contributing educational content (articles, webinars, etc.)

Speaking at network events

Mentoring other professionals

Partnering on client projects

What do you hope to gain from membership in the Golden Life Business Alliance?

How did you hear about the Golden Life Business Alliance?

Professional References (Please provide names and contact information for 2-3 professional references)

Membership Terms

Membership in the Golden Life Business Alliance includes:

Listing in our professional directory
Referral opportunities from the network
Access to network events and resources
Collaboration opportunities with other members
Marketing support through our channels

Annual membership fees range from $500-$2,500 based on service category and firm size. Approved applicants will receive detailed membership information.

I understand that this is an application for professional membership and that all information provided will be verified. If accepted, I agree to uphold the mission and values of the Golden Life Business Alliance.

Golden Life Business Alliance Professional Membership Application