Founder Application Form

Founder Application

Complete the form below accurately indicating your potentials, interest, and suitability for becoming a Founder Member for ATR Media Room - a digital and in person members-only club for Media enthusiast in Atlanta, GA. ATR Media Room will launch in 2022.
Name:*

First NameMiddle NameLast Name
Birth Date*

MonthDayYear
Phone Number:*
E-mail Address:
example@example.com
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How did you hear about us?*

ATR Media Room websiteWalk-InTikTokEmployeeInstagramWeb SearchWord of MouthOther (please specify)
Other:
Upload Resume:*

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Job Skills & Training

Please include any relevant skills, certifications, or training that are not listed on your resume.
Describe your skills:
Training or Certifications:
Interest in Becoming a Founder

Please describe your interest in becoming a Founder for ATR Media Room.
Why do you wish to become a Founder for ATR Media Room?*
What do you hope to accomplish as a Founder for ATR Media Room?*
How will your skill set align with ATR Media's mission to amplify black storytellers and their stories?*
References

Please list two (2) references that are familiar with your work life.
Reference 1
Name:*

First NameLast Name
Relationship*
Email*
example@example.com
Phone Number*
Years Known:*
Reference 2
Name:*

First NameLast Name
Relationship*
Email*
example@example.com
Phone Number*
Years Known:*
Review and Submit Application

By my signature below, I certify the information I provided on and in connection with this form is true and correct to the best of my knowledge. I also understand that any false statements or deliberate omissions on this form will disqualify my application and may subject me to legal actions for fraudulent misrepresentation.
Signature*

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Date*

MonthDayYear
Date
Submit

Thank you for your interest in becoming a Founder for ATR Media Room! If we are interested in your application, someone from our team will contact you. Please review your application before submitting. Changes to the application cannot be made after submission.
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Founding Member ApplicationThis is an application to become one of twenty-five Founding members of ATR Media Room- a member-only platform for media enthusiast. As a Founding member you will be highlighted on the Atlanta platform digitally and in the Atlanta headquarters once complete. The Qualification to be a founding member include: 1. Specializing in a field that relates to media professionals. 2. Availability for monthly meeting to improve the business plan and initiatives. 3. Provide a reduced rate for members to use your services. 4. Complete an application 5. Pay a $49 application fee
$49.00

Total

$0.00

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Choose from one of the PayPal options to make your payment.

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Founder Application

Job Skills & Training

Interest in Becoming a Founder

References

Reference 1

Reference 2

Review and Submit Application

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