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Southwest Johnson County Referral and Networking Group Application

Southwest Johnson County Referral and Networking Group Application

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Published by Chris Dowell
Southwest Johnson County Referral and Networking Group Application
Southwest Johnson County Referral and Networking Group Application

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Published by: Chris Dowell on Sep 10, 2013
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09/10/2013

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SWJOCO Referral and Networking Group APPLICATION
Date:__________________ 
PART I
(Please print and answer all questions)
Applicant’sBusiness Name:______________________________________________ Business Address:____________________________________________ City:______________________________State:_______Zip:__________ Business Phone: _____________________________________________ Cell Phone: ____________________ Fax No._____________________ Applicant's Name:_____________________________________ Home Address: _______________________________________ City:________________________ State:_____ Zip:__________ Home Phone:_________________________________________ E-mail Address:__________________________________________________________________________________________ Birthdate:______________________________________________________________________________________________ Facebook Address: _______________________________________________________________________________________ Google+ Address: ________________________________________________________________________________________ 
 __________________________________________________________________________________________________________ PART II (
Please read carefully
) APPLICATION PROCESS
1.
A prospective member may attend two meetings as a visitor. Prospective members then complete this application and it to theExecutive Committee or Membership Committee for review.
2.
The Membership Committee completes the screening process and notifies the prospective member and the chapter President of acceptance or non-acceptance
before the next meeting
.
3.
The President announces new members and inducts them at the next meeting.
 ______________________________________________________________________________________________________________________________ _____ 
PART III (
Answer all questions
) EDUCATION/BACKGROUND/INFORMATION
1.
Experience in Field/Occupation (bespecific:_______________________________________________________________________________  ___________________________________________________________________________________________________________  ____________  ___________________________________________________________________________________________________________  ____________ 
2.
Education background in Field/Occupation or Degrees, Licenses or Credentials required to perform inField/Occupation:_____________________________________________________  ___________________________________________________________________________________________________________  ___________________________________________________________________________________________________________ 
PART IV
1.
Is the occupation under which you are applying for membership a full or part-timeoccupation?______________________________________ 
2.
How long have you been with the company you are representing today? ________________________________________________________ 
3.
Are you willing to make the commitment to arrive at our weekly meetings on time, stay throughout the meeting, bring qualified
 
referrals and help the group chapter continue to grow by invitingvisitors?__________________________________________________________________ 
4.
Is there an individual who would be willing and able to attend meetings on your behalf, should you be unable toattend?__________________ 
5.
What do you expect to contribute to thischapter?___________________________________________________________________________  _______________________________________________________________________________________________________  _______________________________________________________________________________________________________  ________________________ 
6.
What is your ability to bring qualified referrals or visitors? ___________________________________________________________________  _______________________________________________________________________________________________________  _______________________________________________________________________________________________________  ________________________ 
7.
Do you belong to any other networking organizations?___________ If so, pleaselist_____________________________________________________________________________________________________  _______________________________________________________________________________________________________ 
8.
Is there any business or member in the group that you can not refer to?
____________________________________________________  _______________________________________________________________________________________________________________ 9.
How long have you been doing business in Gardner?
___________________Years
 
Revised 8/2013
PART VPERSONAL/BUSINESS REFERENCES
1.
Name: _________________________________________________ Position: ___________________________________________________ Business: ______________________________________________ Phone: _______________________ Fax:_________________________ Personal/Business Relationship (describe): _______________________________________________________________________________________________________  _______________________________________________________________________________________________________  ____________ 
2.
Name: _________________________________________________ Position: ___________________________________________________ Business: ______________________________________________ Phone: _______________________ Fax:_________________________ 
 
Business Relationship (describe): _______________________________________________________________________________________ 
3.
Name: _________________________________________________ Position: ___________________________________________________ Business: ______________________________________________ Phone: _______________________ Fax:_________________________ Business Relationship (describe): _______________________________________________________________________________________ 
 NOTE: You may attach resume or biography for additional information. Thank you.
Applicant's Signature
 __________________________________________ PART VI -----MEMBERSHIP COMMITTEE USE ONLY-----
Verified Information and References:
Yes
 
 NoCOMMENTS:________________________________________________________________________________  __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ _______________________ Approved_______________ ApprovedProfession:______________________________________________ Declined _______________ Signature Membership Committee, V.P. ______________________________ 
Revised 9/2013

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