Black Design Collective Affiliate Membership Application
Name
*
First Name
Last Name
Membership Category Being Applied for
*
Affiliate
Type of Affiliate Work you Do
*
Model
Photographer
Videographer
Media / Press
Stylist
Educator
Other - please specify below
Referred By. If you were not referred please place NA.
Other
*
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Website
*
Please attach a headshot
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Please provide a brief bio for yourself
*
Instagram
Facebook
Present Occupation
What school did you attend? What degree did you earn? If you did not attend college please place NA in the answer.
*
What experience do yo have working in the design field or for a designer. If you have worked for a brand or design house please share this information as well.
*
Please attach a couple of pictures of your work.
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What areas are you looking for assistance with from Black Design Collective?
*
Is there anything else you would like for Black Design Collective to know about you?
*
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