Ethos Squared Membership Application Form
Welcome & Eligibility
Welcome to the application for Membership at Ethos Squared. This is your opportunity to join a global community of influential diasporans dedicated to cultural elevation, creative collaboration and continental reconnection. This form will take around 10 minutes to complete.
About You
Name
First Name
Last Name
Preferred Name if Different
Pronouns
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
City of Residence
Citizenship(s)
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Professional
Profession/Industry or Area of Impact
Linked In or Website
Instagram/Social Handle (Optional)
Diaspora Identity & Alignment
How would you describe your cultural background and diasporic experience?
What Inspires You About Ethos Squared?
How do you see yourself contributing to the community?
What's something you believe about Africa or the diaspora that the world needs to hear?
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Membership Fit
Which Ethos Offerings Interest You Most?
Ethos Connect
Ethos Experiences
Ethos Media
Business/Investment Opportunities
Which Membership tier are you applying for?
Gold
Platinum
Diamond
How did you hear about Ethos Squared?
*
Referral
Social Media
Event
Other
If "Referral" Who referred you?
Were you referred by a current member
Please Select
yes
no
If "Yes" member's name or email or referral code
Payment
A processing fee of $100 is required. Should your application be accepted this fee will be credited towards the annual membership fee.
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Subscription Name
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Free
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Submit
Should be Empty: