MMN Elite Individual Membership Application

Elite Individual Membership Application

It's time to BE MONUMENTAL!
Name*

First NameLast Name
Birthplace/Hometown
Current Company*
Current Title*
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Date of Birth (For Virtual Birthday Cards)*

MonthDayYear
Date
If accepted as an MMN Elite Individual, annual membership fee is $1000 (annually, broken up monthly) to cover the costs of programming and events. Are you ready to make this investment into yourself and the success of the network?*

YesNo
Do you identify as a Black man?*

YesNo
What is you highest level of education?*

High School / GEDAssociates DegreeBA / BSMA / MPA / MBA (or comparable)JD / MD / PhD
Would you please share your LinkedIn profile?*
Please upload a current professional headshot*

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Please upload a current copy of your resume*

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Additional Information:

As a potential new member, we would like to get to know you a little better and look forward to reading your responses to the prompts below.
How did you hear about us?
Please indicate the MMN benefits you are most interested in:

Private Networking & Social EventsAccess to Premiere Collective of Black Male ExecutivesStrategic Executive FunctionsElevated Professional Development OpportunitiesHigh-Level RoundtablesThought Leadership Features & Speaking EngagementsOther
Which of MMN's three key principles (Harnessing Leadership, Elevating Excellence, and Delivering Impact) most resonate with you? Why?*

0/250
In 250 words to less, please share why you are interested in joining MMN.*

0/250
In 250 words to less, please share what you hope to gain from joining MMN.*

0/250
In 250 words to less, please share what you hope to contribute to the Monumental Men's Network as a member.*

0/250
Please share what special skills or interests you would like to contribute to the Monumental Men's Network.*

0/250
Do you have any other professional or organizational affiliations?
Declaration:

I certify that all information provided in this application is true and accurate to the best of my knowledge. I understand that membership approval is at the discretion of the association and may be subject to review.
Signature
Date

MonthDayYear
Date
Please verify that you are human*
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Elite Individual Membership Application