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.

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? *