2 Step BNI CA Northern Application

2 Step BNI CA Northern Application
Name*

First NameLast Name
Company Name*
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Mobile Number
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Professional Classification (if unsure, go to end of list and click that)*
Who introduced you or invited you to BNI?*
BNI Chapter Name (If unknown - choose Help Me Find a Chapter)*
IF chose HELP ME FIND A CHAPTER, what Meeting Format do you prefer?

Any meeting formatIn-PersonHybrid (First week of the month in-person, other weeks online)Online (All chapter meetings online)
Language
MEMBERSHIP TERM
Who is Paying for the Membership (note: only one person can be the member, any changes will go through the normal application and vetting process, with no guarantee of acceptance)*

Personal (person's name can't change)Corporate (company name can't change)
Please Enter Name of who is paying
Do you have remaining Credit from an earlier BNI membership?

NoYes
Acknowledgement that the New Member Welcome Kit will be delivered to the shipping address provided above.*

I acknowledge
Experience and Credentials
Experience in Professional Classification (the one listed earlier)
Length of time in Professional Classification
Education,Current Licenses, Credentials, and other to perform Professional Classification
Has your professional license ever been revoked or suspended?

NoYes
IF YES, provide details
Is the Professional Classification you chose your PRIMARY occupation

YesNo
Standard and Expectations
Are you able and willing to make the commitment to arrive at the weekly meetings on time and stay through the 90 minutes, attend the Member Success Program and do you agree to abide by the BNI Member Policies, Guidelines and Code of Ethics?:

YesNo
Are you willing and able to send a substitute if you are unable to attend a meeting?

YesNo
Have you ever been a member of a BNI Chapter?

YesNo
If yes, please provide the Chapter Name, State (or BNI Region), and Dates of Membership
Are you able and willing to make the commitment to arrive at the weekly meetings on time and stay through the 90 minutes, attend the Member Success Program and do you agree to abide by the BNI Member Policies, Guidelines and Code of Ethics?:

YesNo
Do you belong to other networking organizations?

YesNo
If yes, please list
Have you ever been convicted of a felony?

YesNo
If yes, please provide details and year
Business References
Name
Position
Company
Phone Number
Please enter a valid phone number.
Email
example@example.com
Business Relationship
Name
Position
Company
Phone Number
Please enter a valid phone number.
Email
example@example.com
Business Relationship
Electronic Signature

I agree that the signature below acknowledges my agreement to BNIs terms.
Signature - I agree to all terms and conditions*

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Please note, after compleing this form and payment, you still have one more step to complete your application.

This is to complete the online video interview: https://app.willotalent.com/invite/V1D3cx/
Should be Empty:

2 Step BNI CA Northern Application

MEMBERSHIP TERM

Experience and Credentials

Standard and Expectations

Business References

Electronic Signature