Engage Young Professionals Application
Apply to join Engage Young Professionals by completing this application form. Please answer all questions fully.
Full Name
*
First Name
Last Name
Personal Email Address
*
example@example.com
Work Email Address
*
example@example.com
Which email address would you prefer we use?
*
Personal
Work
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Can we text you?
*
Yes
No
Date of Birth
*
-
Month
-
Day
Year
Date
Employer
*
What are your goals for participating in the Engage program?
*
Are you or your employer a member of the Bartow Chamber of Commerce? If the organization you are employed by is a member of the Bartow Chamber you are also a member of the Chamber. If you aren't sure if your organization is a member check our tour member directory on the website.
*
Yes. I am a Chamber Member and understand there will be $20 Annual Due Charge
No. I am not a Chamber Member and understand there will be $75 Annual Dues Charge
Submit Application
Should be Empty: