Chamber Executive Form

CHAMBER EXECUTIVE FORM:

FOR PARTNERS ONLY. PLEASE COMPLETE BELOW.
Business Empowered Mississippi's Chamber Executives Club is accepting applications for certified professional coaches, speakers, trainers/teachers, and/or ambassadors who will volunteer a portion of their time supporting Business Empowered Mississippi's new partners to better serve their needs. These leadership roles are loaded with great benefits such as:

Opportunity to sign up for the Be Empowered Speakers Club and/or Executive Coaching Team. These are programs made available to maximize and certify you as a trained professional speaker or coach;
The first choice in paid coaching, speaking, and training opportunities with chamber partners;
Be the first to welcome and share your product, services, and offerings;
Support for the Board of Governors in carrying out leadership tasks.
Featured on website and social media pages with a link that leads to your contact information (website, email, etc.);
The annual membership fee is $99.00 to sign up for the Chamber Executives Club 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 Executives Chamber Club is something that can benefit you, please complete the information provided here. For additional information not provided in the link, please email us at info@bemississippi.com.
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 or program are you applying for? Check all that applies.

Coach Speaker Trainer/Teacher Ambassador Executive Coaches Club (Certification Training Program) Be Empowered Speakers Club (Certification Training Program) 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

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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 Executives Annual Club Fee Annual Membership for Coaches, Speakers, Trainers/Teachers, and Ambassadors.
$ 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: