MOSAIC CLUB TRACKING FORM

							48ffdf71-b560-4da6-a025-1bfd879bb5ac.rtf
02/09/11


                                  MOSAIC NEW CLUB TRACKING FORM:
Basic Startup form with who is requesting, the contacts, etc...
(This is like a ledger to keep track and a record)

For the New club, please fill in the following information below the === line.


==================================================================
LOCATION:
National Mosaic Contact(s):
Is there an existing Mosaic group within 100 miles? (Yes or No)
How they heard about us:
CONTACT PERSON(S):
PHONE NUMBER(S)
CURRENT WEBSITE URL(if they have one):
REQUEST FOR MOSIAC WEBSITE: (Yes or No)
          Web and Email info
Help required (i.e. monies, guidance, etc)
          Bank Accounts and Start-up Money
          Web-site help
          Guidance from:
National Rep. That lives the closest:
Is Insurance required for start-up
COMMENTS AND NOTES:




==================================================================
LOCATION:
National Mosaic Contact(s):
Is there an existing Mosaic group within 100 miles? (Yes or No)
How they heard about us:
CONTACT PERSON(S):
PHONE NUMBER(S)
CURRENT WEBSITE URL(if they have one):
REQUEST FOR MOSIAC WEBSITE: (Yes or No)
          Web and Email info
Help required (i.e. monies, guidance, etc)
          Bank Accounts and Start-up Money
          Web-site help
          Guidance from:
National Rep. That lives the closest:
Is Insurance required for start-up
COMMENTS AND NOTES:




                                                                  Page 1 of 4
48ffdf71-b560-4da6-a025-1bfd879bb5ac.rtf
02/09/11




==================================================================
LOCATION:
National Mosaic Contact(s):
Is there an existing Mosaic group within 100 miles? (Yes or No)
How they heard about us:
CONTACT PERSON(S):
PHONE NUMBER(S)
CURRENT WEBSITE URL(if they have one):
REQUEST FOR MOSIAC WEBSITE: (Yes or No)
          Web and Email info
Help required (i.e. monies, guidance, etc)
          Bank Accounts and Start-up Money
          Web-site help
          Guidance from:
National Rep. That lives the closest:
Is Insurance required for start-up
COMMENTS AND NOTES:




==================================================================
LOCATION:
National Mosaic Contact(s):
Is there an existing Mosaic group within 100 miles? (Yes or No)
How they heard about us:
CONTACT PERSON(S):
PHONE NUMBER(S)
CURRENT WEBSITE URL(if they have one):
REQUEST FOR MOSIAC WEBSITE: (Yes or No)
          Web and Email info
Help required (i.e. monies, guidance, etc)
          Bank Accounts and Start-up Money
          Web-site help
          Guidance from:
National Rep. That lives the closest:
Is Insurance required for start-up
COMMENTS AND NOTES:




                                           Page 2 of 4
48ffdf71-b560-4da6-a025-1bfd879bb5ac.rtf
02/09/11




==================================================================
LOCATION:
National Mosaic Contact(s):
Is there an existing Mosaic group within 100 miles? (Yes or No)
How they heard about us:
CONTACT PERSON(S):
PHONE NUMBER(S)
CURRENT WEBSITE URL(if they have one):
REQUEST FOR MOSIAC WEBSITE: (Yes or No)
          Web and Email info
Help required (i.e. monies, guidance, etc)
          Bank Accounts and Start-up Money
          Web-site help
          Guidance from:
National Rep. That lives the closest:
Is Insurance required for start-up
COMMENTS AND NOTES:




==================================================================
LOCATION:
National Mosaic Contact(s):
Is there an existing Mosaic group within 100 miles? (Yes or No)
How they heard about us:
CONTACT PERSON(S):
PHONE NUMBER(S)
CURRENT WEBSITE URL(if they have one):
REQUEST FOR MOSIAC WEBSITE: (Yes or No)
          Web and Email info
Help required (i.e. monies, guidance, etc)
          Bank Accounts and Start-up Money
          Web-site help
          Guidance from:
National Rep. That lives the closest:
Is Insurance required for start-up
COMMENTS AND NOTES:




                                           Page 3 of 4
48ffdf71-b560-4da6-a025-1bfd879bb5ac.rtf
02/09/11




==================================================================
LOCATION:
National Mosaic Contact(s):
Is there an existing Mosaic group within 100 miles? (Yes or No)
How they heard about us:
CONTACT PERSON(S):
PHONE NUMBER(S)
CURRENT WEBSITE URL(if they have one):
REQUEST FOR MOSIAC WEBSITE: (Yes or No)
          Web and Email info
Help required (i.e. monies, guidance, etc)
          Bank Accounts and Start-up Money
          Web-site help
          Guidance from:
National Rep. That lives the closest:
Is Insurance required for start-up
COMMENTS AND NOTES:




==================================================================
LOCATION:
National Mosaic Contact(s):
Is there an existing Mosaic group within 100 miles? (Yes or No)
How they heard about us:
CONTACT PERSON(S):
PHONE NUMBER(S)
CURRENT WEBSITE URL(if they have one):
REQUEST FOR MOSIAC WEBSITE: (Yes or No)
          Web and Email info
Help required (i.e. monies, guidance, etc)
          Bank Accounts and Start-up Money
          Web-site help
          Guidance from:
National Rep. That lives the closest:
Is Insurance required for start-up
COMMENTS AND NOTES:




                                           Page 4 of 4