Application Form

TO BE COMPLETED BY NEW MEMBERS, TRANSFERS AND CATEGORY CHANGES

1. Describe you experience in your field/occupation (be specific):

2. Describe your educational background in your field/occupation. Include degrees, licenses or credentials required to perform your job:

3. Is the occupation under which you are applying for membership, a full or part-time occupation?

Full Time

Part Time

4. How long have you been with the company you are representing today?

5. What do you expect to contribute to the chapter?

6. What is your ability to bring qualified referrals, introductions or visitors to the chapter?

7. Do you belong to other networking organizations?

YES

If YES, please list the organizations:

BUSINESS RELATIONSHIP

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