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
Is there anything else we need to know?

0/100
MC Approval
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Requested By

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