Strategic Alliance Group
Membership Application
Name
*
First Name
Last Name
Title
*
Company Name
*
Cell Number
*
Please enter a valid phone number.
Work / Other Number
Please enter a valid phone number.
Work Email Address
*
example@example.com
Who Invited You?
*
Industry
*
Product or Service Description
*
Is this your full time / primary occupation?
*
Other
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Industry and Current Position Experience
Length of experience in your profession
*
Length of experience with your current company
*
Relevant Licenses, Certifications, and/or Degrees held
Have you ever had a license or certification revoked, or been found guilty of a felony?
*
No
Yes
n/a
If yes, please provide details
Anything else you want us to know about your professional experience?
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Please provide two relevant work references. A referral partner or client is preferred.
Our membership committee will reach out to the references listed below. Please let them know to expect to hear from us.
Reference 1 Name
*
First Name
Last Name
Reference 1 Company (if reference is a client - enter "client")
*
Reference 1 Position
*
Reference 1 Contact Phone Number
*
Please enter a valid phone number.
Reference 1 Email Address
*
example@example.com
Reference 2 Name
*
First Name
Last Name
Reference 2 Company
*
Reference 2 Position
*
Reference 2 Phone Number
*
Please enter a valid phone number.
Reference 2 Email
*
example@example.com
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Can you commit to attend weekly meetings?
*
Yes
No
Are you willing to send a substitute if you are unable to attend a meeting?
*
Yes
No
Are you a member of any other networking organizations?
*
Yes
No
If yes, please provide details
How do you think you will benefit from your membership in SAG?
How will our other members benefit from your membership in SAG?
Thank you for your interest in our group. We will be in touch with you shortly to discuss next steps.
Please sign below to acknowledge, then click to submit your application.
The information I have provided on this form is true and accurate to the best of my knowledge.
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Please verify that you are human
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