EO Gurgaon Application Form

EO Gurgaon Membership Form
Before you apply, please confirm that you have read the eligibility criteria, and that you are eligible to be a member of EO Gurgaon
Read and Understand the instructions.*

Yes, I have
If selected, you will be required to furnish details to verify eligibility for membership to EO Gurgaon.
I. Personal Data:

Please tell us about yourself
Full Name*

First NameLast Name
Birthdate:*

MonthDayYear
Please upload a high resolution picture of yourself:

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Mobile No.:*
E-mail :*
Where the confirmation will be send to
Phone Number*

Area CodePhone Number
Home Address :*

Street Address

Street Address Line 2

City State

Pin CodeCountry
Gender:

MaleFemale
Social Media Links:
LinkedIN:*
Facebook:*
Instagram:*
Have you ever applied to any EO chapter anywhere in the world in the past? If yes, Please specify the Chapter Name and when.*
How did you hear about EO?*
Why do you want to join EO?*

0/600
II. Business Information:
In your current business, are you a first generation entrepreneur?*

Yes, I am a first generation entrepreneur.No, this company was started by a previous generation of my family
For the rest of this application process, please only furnish information about the 'Qualifying Company', unless specifically asked otherwise.
What is the address of your 'Qualifying Company'?*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
What is the name of your 'Qualifying Company'?*
What is your current designation in your Qualifying Company'?*
Please describe in detail the nature of business:*
In the most recent financial year, what was the revenue of your 'Qualifying Company'?*
You can enter this field either in $M or INR Cr. Be sure to mention the currency & units you are using in the text field.
What percent of the 'Qualifying Company' do you personally own?*
What percent of the 'Qualfying Company' does your immediate family (including you) own?*
This is the total shareholding held by you and your immediate family in your 'Qualifying Company'
How many full-time employees are working in the 'Qualifying Company' today?*
What year did you join the 'Qualifying Company'?*
Apart from the 'Qualifying Company', are there any other companies that you own? Please list those here, along with their revenue and your shareholding in those companies. *
What is your operating responsibility in the 'Qualifying Company'?*

I head the entire companyI head one or more profit centers (verticals)I control one or more departments (horizontals)Other
Please describe in detail, your role in qualifying company. Please feel free to mention significant achievements, disruption or impact that you have brought on the business/industry.*
Is there anything more you want us to know about your work experience outside the 'Qualifying Company'? Do you have prior work experience that you would like us to know about?*
The information you have furnished above is subject to verification before consideration for membership.
III. Education Information:
Highest Education Qualification Degree*
Name of the college or university where you received your Highest Education Qualification*
Year of completion of Highest Education Qualification*
Please list any other education degrees you hold, along with Institute and the year that you received them. *
What was the name and city of your high school and the year of Passing?*
IV. Family Information:
What is your current marital status?*

SingleMarriedDo not wish to disclose
If married, what is the name of your spouse / life partner?*
Please provide the name of your children and their ages:*
Please tell us about Spouse / Life Partner's education, professional or social background?*
V. Personal Information:
Please tell us about your hobbies:*
Are you skilled enough in any field to make a formal presentation to EO Members? If yes, list the fields. *
Example: Financial Analysis, Operational Efficiency, Automation etc.
Please list any industry or social groups or organizations that you belong to *
List the organizations whose main purpose is to grow and exchange ideas here.
Are you related to any member or spouse in EO Gurgaon ? If yes please Mention Name & Relationship:*
VI. Extras:
Please list two references who would be happy to talk about your application to EO Gurgaon.
Reference 1*
Mobile No.:*
How do you know Reference 1?*

CustomerBusiness PartnerFriendEO MemberOther
Reference 2*
Mobile No.:*
How do you know Reference 2?*

CustomerBusiness PartnerFriendEO MemberOther
VIII. Applicant's E-Signature
By signing (typing your legal name) in the space below, you are certifying that all information is correct and that you are the person completing this application. When you press the submit button, you will receive an email confirmation that your application was received. Please print for your records and retain as verification of your application.
E-Signature:*
Please verify that you are human*
Should be Empty:

EO Gurgaon Membership Form

I. Personal Data:

II. Business Information:

III. Education Information:

IV. Family Information:

V. Personal Information:

VI. Extras:

VIII. Applicant's E-Signature