Membership Application

Apply to join Notable Networkers

One seat per industry, zero competition. Complete the four short sections below — it takes about ten minutes — and your application goes straight to our membership committee.

First name

Last name

Business name

Business address

City

State

ZIP

Business phone

Website (optional)

Fax (optional)

Describe your product or service (be specific)

Sponsor name (optional)

Fee schedule

Chapter Fee$199.00
Room Dues (Quarterly)$78.00
Chapter Fee + Full Year Room Dues$450.00

A $25 late fee applies to late room dues.

I understand that all fees are non-refundable once accepted.

Experience

Education in your profession; credentials required to perform it

Are you full or part time?

How long with your current company?

Willing to commit to a weekly meeting and abide by the rules of conduct?

Able to get a substitute from your organization if you can't attend?

What do you expect to contribute to Notable Networkers?

What is your ability to bring qualified referrals to the group?

Do you belong to other networking organizations?

If yes, please list (optional)

Have you ever been convicted of a felony?

Reference 1

Name

Position (optional)

Business (optional)

Phone (optional)

Fax (optional)

Business relationship (optional)

Reference 2 (optional)

Name

Position

Business

Phone

Fax

Business relationship

Additional notes / biography (optional)

I hereby declare that all the information I have included in this application is true and correct, and that any misrepresentation or false statements may be grounds for rejecting my application or, if discovered after my application is approved, grounds for termination from the group. Furthermore I understand if accepted to the group, weekly attendance is required as part of membership and 3 absences are allowed in a 6 month period. If I cannot attend, I will send a substitute in my place.

I have read and agree to the declaration above.

Signature — type your full name

Typing your name here serves as your electronic signature, dated today.

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