Chamber Executive Form

CHAMBER EXECUTIVE FORM:

FOR PARTNERS ONLY. PLEASE COMPLETE BELOW.
Business Empowered Mississippi's Chamber Executives are certified professional coaches, speakers, trainer/teachers and/or ambassadors who volunteer a portion of their time supporting Business Empowered new partners to better serve their needs. These leadership roles are loaded with great benefits such as:
- First choice in paid coaching, speaking and training opportunities with partners and Business Empowered Chamber of Commerce.
- Be the first to welcome and share your offerings.
- Support for the Board of Governors in carrying out leadership tasks.
- Featured on website and social media pages with link that leads to your contact information (website, email, etc.)
The annual membership fee is $99.00 to sign up for a Chamber Executive to serve in all four capacities or you can choose the divisions of which you would like to serve below for only $29 annually. If the Executive Chamber is something that can benefit you, please complete the informatoin below and submit. You will be notified of the next Chamber Executive meeting.
Full Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number *
E-mail *
example@example.com
Website
example@example.com
Facebook
example@example.com
Instagram
example@example.com
LinkedIN
example@example.com
What Executive Role are you applying for?

Coach Speaker Trainer/Teacher Ambassador All of the above Other
If you chose "Other" which Executive Roles are you applying for?
How long have you been coaching?
What is the name of the organization of which you were certified as a coach?
Upload Professional Photo *

Cancel of
Upload 7-10 Sentence Bio (Any amount larger than this will be returned for editing) *

Cancel of
Submit 7-10 Sentence Bio:(Any amount larger than this will be returned for editing)
Make Payment *
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Chamber Executive Annual Membership for Coach, Speaker, Trainer/Teacher and Ambassador
$ 99.00 one-time payment

Chamber Coach Annual Membership for Coaching Opportunities.
$ 29.00 one-time payment

Chamber Speaker Annual Membership opportunities for Speaking.
$ 29.00 one-time payment

Chamber Trainer/Teacher Annual Membership opportunities for Training and/or Teaching.
$ 29.00 one-time payment

Chamber Ambassador Annual Membership opportunities to serve in your community and across your state as a Chamber Ambassador. The fee pays for your badge.
$ 19.00 one-time payment
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CHAMBER EXECUTIVE FORM: