100 Black Men of Ghana – Membership Application
Welcome, and thank you for your interest in joining the 100 Black Men of Ghana. Our mission is to improve the quality of life within our communities and enhance educational and economic opportunities for all. Please complete this application thoroughly. All information will be kept confidential and used only for the purposes of membership consideration.
Full Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Nationality
Phone Number
Email Address
Residential Address
Current Occupation/Title
Employer/Company
Field of Expertise
Education
Business
Finance
Law
Medicine
Technology
Community Development
Other
Years of Professional Experience
0–5
6–10
11–20
20+
LinkedIn Profile or Website (Optional)
Why do you want to join the 100 Black Men of Ghana?
What strengths or resources can you contribute to the organization?
Have you been a member of any similar organizations?
Yes
No
Areas of Interest in Service
Mentoring
Education
Health & Wellness
Economic Empowerment
Leadership Development
Advocacy
Other
Are you willing to commit your time to mentoring and community service activities?
Yes
No
Are you able to pay annual membership dues (amount will be shared upon approval)?
Yes
No
Do you agree to uphold the values and mission of 100 Black Men of Ghana?
Yes
No
Reference 1: Name, Phone, Relationship
Reference 2: Name, Phone, Relationship
Final Statement
I certify that the information provided in this application is true and complete to the best of my knowledge. I understand that providing false information may result in disqualification from membership consideration.
Submit Application
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