Business Affiliate Application

Men and Women of Empowerment is a nonprofit organization with a mission to serve, uplift and improve the lives of others through community outreach and youth mentoring.

Thank you for your interest in becoming a Business Affiliate of Men and Women of Empowerment. Please complete the application below.

If you have any questions, please contact us via email: info@MenAndWomenofEmpowerment.org.
Name*

First NameLast Name
Address*

Street Address

Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Email Address*
Business Affiliate

Please affiliate my business with Men and Women of Empowerment
Business Name
Business Services
Areas of Expertise*

MarketingPublic RelationsAdministrative TasksHuman ResourcesSpecial EventsPublic SpeakingFinance / FundraisingLegalManagementService ProviderProject ManagementResearchOther
Professional Background
Educational Background
Special Skills / Training / Talents
Please list any medical/physical conditions, beliefs or special needs that would prevent your or limit your ability to perform tasks and duties. Indicate N/A if none. *
Reference #1*

Name Company / Affiliation Phone #
Reference #2*

Name Company / Affiliation Phone #
Reference #3*

Name Company / Affiliation Phone #
Emergency Contact*

Name Company / Affiliation Phone #
Emergency Contact

Name Company / Affiliation Phone #
Emergency Contact

Name Company / Affiliation Phone #
Agreements*

(1) I give my voluntary permission to Men and Women of Empowerment to use either photographs, video recordings, or my story for publication in fundraising and/or public relations efforts such as newsletters, brochures, newspaper articles, website, displays, films, etc. both physical and virtual in format. (2) As a condition of serving as a Business Affiliate, I understand that I may have access to information regarding clients, donors, and proprietary business information; therefore, I agree that I will not in any manner reveal or disclose information to any person outside of Men and Women of Empowerment Board of Directors, staff or volunteers during or after my term of service unless such information is specifically requested by and accompanied by a signed release. (3) I indicate to the best of my knowledge that the information contained in this application is complete and accurate. I understand that providing false information is grounds for not choosing me for a volunteer position. I also understand Men and Women of Empowerment may administer a background or reference check, at no cost to me, using the above information I provided, for the safety of our clientele. I further understand negative results will not always preclude me from volunteering, but may affect the areas in which I may serve. Men and Women of Empowerment holds all information obtained to be held in strict confidence.
Digital Signature*
First and Last Name
Should be Empty: