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Join the Club


Please only complete this form if you are certain you are not already a member of the Detroit Economic Club.

Member type:

(required)

Who Referred You:

(Enter First and Last Name of Person or N/A)

Email Address of Referrer:

(Please enter a valid email address or N/A)

Personal Information

Prefix:


First Name:

(required)

Middle Intial:


Last Name:

(required)

Suffix:


Title:


Birth date:

    (required if Junior Executive selected)

Gender:

(required)

Contact Information

Company Name:


Work telephone:

(required)

Home telephone:


Fax:


Email:

(required)


A work or home address is required.

Work Address

Address 1:


Address 2:


City:


State/Province:


Zip/Postal code:


Country:


 

Preferred mailing address
Preferred billing address

Home Address

Address 1:


Address 2:


City:


State/Province:


Zip/Postal code:


Country:


 

Preferred mailing address
Preferred billing address

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