Ambassador Program Application
First Name   M.I.
Last Name
SEG Affiliation/Employer
Physical Address
City
State
Zip Code
Work Address
City
State
Zip Code
Email
Home Phone - -
Work Phone - -
Cell Phone - -
Preferred Method of Contact
Credit Union of Georgia Member Since
Account Number*

Favorite Prodcut or Benefit of Membership with Credit Union of Georgia:


Why would you like to be a Credit Union of Georgia Ambassador?

SIGNATURES

Check here if you agree to the duties and responsibilities of being a Credit Union of Georgia Ambassador for your Select Employee Group (SEG).

_______________________________________________________________________________________

SIGNATURE                                                                                                DATE

*Must be a current, active member of Credit Union of Georgia to be an Ambassador for the Credit Union.

PLEASE RETURN COMPLETED APPLICATION TO:
Credit Union of Georgia
Attn: Director of Business Development
P.O. Box 2148
Woodstock, Georgia 30188-1375