Membership Application
We are pleased to learn you are interested in becoming a member of the Jewish Business Network of Arizona. Eligible applicants work in unique fields or professions that do not conflict with those represented by existing members and are not active members of other Jewish business leads or referral organizations. Completion of this application assists the Membership Chair in proposing your candidacy for acceptance to the Executive Board.
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Referral Source:
Name
*
First Name
Last Name
Email
example@example.com
Cell Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Profession/Business Category
Please Select
Accounting
Art
Allied Health
Consulting
Educational
Engineering
Labor
Legal
Medical
Service
Technical
Vocational
Other
Length/Duration of occupation?
Business Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Business Fax
Please enter a valid phone number.
Format: (000) 000-0000.
Company Name
*
Website
*
Business Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Additional Business Addresses (if any)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Experience in field of expertise (be specific):
What do you believe your greatest contribution to the Jewish Business Network of Arizona would be?
What is your ability to bring qualified referrals or visitors to our meetings?
Professional References
Please provide contact information for two individuals who can endorse you professionally.
Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Business
Relationship to Applicant
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Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Business
Relationship to Applicant
Please consent to the following statements:
I agree to be personally responsible for the JBN membership.
I agree to abide by the Bylaws and Codes of Ethics of the organizaiton.
I understand that should my membership be terminated for any reason, the seat that I hold shall be open to another prospective applicant.
If applicable, I have made my employer aware that I personally own the seat in JBN regardless of where the funding has come from to pay for this membership. If I leave the group or change employers, the employer has no claim to this seat and it shall be open to another prospective applicant.
I consent to be considered by the Executive Board of the Jewish Business Network of Arizona for membership in JBNAZ.
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
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