Industry Change Request

Industry Change Request
Please use this form to make changes to a member's Industry/seat in the chapter. The Membership Committee (MC) will need to have approved this change before submitting this form to the BNI Atlanta Regional Office.
Member Name*

First NameLast Name
Chapter Name*
Industry/Seat Change*
Company Name Change*
MC Approval*

YESNO, Declined
Date*

MonthDayYear
Date
Requested By*

First NameLast Name
Your Role*
Requestor's Email*
example@example.com
Should be Empty: