MEMBERSHIP APPLICATION
 
Chapter*
 
Business Classification*
 
(if Other, suggest classification)
   
Applicant*
Company Name*
Business Address*
Business City
Business Zip Code*
Position / Title*
Length of Service*
Home Address
Home City
Home Zip Code
Home Phone
Business Phone*
Fax
Cell
Email Address*
Website
 
Keyword description of business (3-5 words)
 
Description of Business and products / services sold*
 
Ideal Client
 
Keywords that should trigger thoughts of a potential client for member
 
What sets you above your competitors?
 
Previous business experience*
 
One on One's*
(Minimum of 5 - 2 must be with a Chapter Leader)
Member Date
Total Number of One on One's
 
Minimum 4 out of 5 Attendance Dates*
Guests brought to Meetings
Who referred you to Team Networking?
 
List any other networking groups of which you are a member
 
Company Data
Date Organized*
Number of Employees*
List three business references with phone numbers*
Name Phone
 
Personal Information
Birthday:
Mo      Day      Year
Spouse's Name
 
Children
 
Pets
 
Hobbies
  
Professional or Civic Organizations
 
Personal Reference*
Name Phone
 

I certify that this information is correct and authorize such information to be used by TEAM NETWORKING. I authorize TEAM NETWORKING to investigate my business reputation*
I agree I disagree
 

* - Required Fields

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