Wufoo

Become a Member

After completing this form, you will be redirected to a page where you may choose the appropriate level of membership and make a payment via Paypal. If you would rather pay by check and send via email, that is ok as well.

Membership Type
Name * Title First Last Suffix
No Spam Policy

We hate spam as much as you do. We will do everything we can to ensure your name does not end up in the databases of spammers and will have an easy opt-in, opt-out policy once we get the beta version of the site live.
Email *
Opt In Mailing Lists Organizational Creation Discussion Event Announcements Monthly Newsletter
Personal Address *

Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country

We will be mailing some physical materials from your membership kits to you, so we need your address. If this is a company membership, you may add that below.
Phone - number only (no symbols or spaces)

Not Required, but helpful for us in organizing flash mobs or reaching you directly about a last minute gathering in your area.
Organization Information

Please fill out the basic information about your organization to be included in the directory, even if this is not an organizational membership.
Organization Name
Your Title at Organization
Organization Address

Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Organization Web Site
Do you or your organization have a: Blog Podcast Video Blog Social Network Online Forum
What are the organization's Social Media URL's for the above?

Please enter one URL on each line for the public Web address of your Blog, Podcast or Video Blog.
On Twitter? What is your username?
On Facebook? Please provide url to your profile.
Using FriendFeed? What is your username?
Organization Memberships

If you are completing this membership form on behalf of your organization, we will contact you separately to gather the names and email addresses for the other members. As a reminder, Small Business / Startup Memerbships are good for three (3) individual's and Corporate Memberships are good for ten (10) individuals. Further, Corporate Memberships will be invoiced and sent separately.
Shirt Order Form (for Professional, SMB and Corporate memberships only)

We need to confirm a bit of information from you so we may process your shirt orders that will be included in your Social Media Club Membership Kits. So the sooner you get this information back to us, the sooner you can start stalking your mailman. Cheers.

Note: Student/Non-Profit memberships will receive a member kit, but this member level does not include a t-shirt.
Which cut would you prefer (option only pertains to American Apparel as Hanes comes in Mens cut only): * Male/Unisex Female cut
Brand of shirt: American Apparel, super slim fit but uber soft (order one size bigger) Hanes/Fruit of the Loom, 50/50 blend (good enough for Michael Jordan) I have enough t-shirts. Put these extra dollars towards National/Local SMC activities.
Size * XS S M L XL 2XL 3XL
Thank you!

We appreciate your support of the Social Media Club. Keep a watch over at www.socialmediaclub.org for upcoming news and events and we look forward to sharing with you!

Note: If you opted for a paid membership level, your welcome kit will arrive 2-3 weeks after payment of your membership has been made.
Do Not Fill This Out

Wufoo

Become a Member

No Spam Policy

Organization Information

Organization Memberships

Shirt Order Form (for Professional, SMB and Corporate memberships only)

Thank you!