Charter Membership Form
Name
*
First Name
Middle Name
Last Name
Preferred Name
*
Email Address
*
example@example.com
Whatsapp Number
*
Please enter a valid phone number.
Phone Number
*
Please enter a valid phone number.
What is the best way to contact you?
*
Gender
*
Please Select
Male
Female
Date of Birth
*
-
Month
-
Day
Year
Date
Company Name
*
Role At Company
*
Industry
*
Are you a Government Contractor?
*
Please Select
Yes
No
Number of Employees
*
Please Select
0 To 10
10 To 20
20 To 30
30 To 40
40 To 50
More than 50
LinkedIn Profile URL
*
Are you currently the Founder/CEO, or have you ever been the Founder/CEO of a business?
*
Please Select
Yes
No
Are you currently in a C-Level role, or have you ever been in a C-Level role at an organization?
*
Please Select
Yes
No
Have you ever attended an OPEN DC Annual Conference?
*
Please Select
Yes
No
Have you attended any other OPEN DC event within the last 24 months?
*
Please Select
Yes
No
Do you know any current charter members of OPEN DC?
*
Please Select
Yes
No
First Charter Member Nominee
*
Email address for the First Nominee
*
example@example.com
Second Charter Member Nominee
*
Email address for the Second Nominee
*
example@example.com
How did you hear about OPEN DC?
*
0/100
Why are you interested in becoming an OPEN DC Charter Member?
*
0/500
Upload Resume
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Consent
*
I consent to pay $750.00 annual fee per year.
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