Membership Application

Membership Application

One Seat. One Industry. Endless Referrals.

Thank you for your interest in the Pinellas Park Gateway Chamber of Commerce Seat-Specific Networking Group.

Please complete the following application to be considered for a seat representing your industry. If neither your primary nor secondary industry seat is available, your application will automatically be placed on the waiting list.
Name

First NameLast Name
Office Phone
Please enter a valid phone number.Format: (000) 000-0000.
Extension
Direct Cell Phone Number
MobileFormat: (000) 000-0000.
Email address
example@example.com
Title / Position
Years, months worked w/ or owned company
# Yr (Years) / # M (Months)

Business Information
Business name
Main Phone Number
Business street address / city / state / ZIP

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Website
Customer Email
Google Business Profile URL
N/A if you do not have google profile
Business Google Rating / # of Reviews
N/A if you do not have google profile
List Other Business Reviews URL's
N/A if you do not have google profile
Current Chamber membership status
Upload Company Logo

Cancelof
What size customers or organizations do you target?

Business Category & Seat Request
Industry Seat Category
What industry category best describes your business?
Specialty
What specific products or services do you specialize in?

Who Do You Primarily Service?

Rows	Target Market / Customer
Top Producing
Just at or Just under Goal
Inconsistant

Business Type:
Specialty - URL's
What specific products or services do you specialize in?
What specific expertise, capabilities, or features distinguish your products or services from others in your industry?

Business Development Goals
What measurable result would you like to achieve within your first six months?
Top Business Development Goal
Who do you need to connect with to accomplish TOP goal?
2nd Business Development Goal
Who do you need to connect with to accomplish 2nd goal?
3nd Business Development Goal
Who do you need to connect with to accomplish 3rd goal?

Referral
What Industries do you have direct connections with?
List all, even if not on the chart above
What professional level do you have direct connections with?
Owners, CEO's, Managers, Sales Reps, Admin
List their specialties, if any
Other......
Describe how you initiate a referral, follow it to completion, and measure its success.

Membership Representative

List 1-2 Reps, for sub pre-approval -

Rows	Name	Phone Number	Email
Primary Contact
1st Designated Substitutes
2nd Designated Substitutes

Primary Contact

Professional Background
Briefly describe your professional experience and qualifications
List current and previously networking group you held/hold membership with.

Member Code of Conduct & Participation Guidelines

Open or Download
By signing below, I acknowledge that I have access to, have downloaded, and have reviewed the Pinellas Park Chamber of Commerce Seat-Specific Networking Group Code of Conduct. I understand its requirements and agree to follow them throughout my participation in the group.
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Member Engagement and Commitments

As a member, I acknowledge and agree to the following:
By signing below, I acknowledge that I have access to, have downloaded, and have reviewed the Pinellas Park Chamber of Commerce Seat-Specific Networking Group Member Engagement and Commitments document. I understand its expectations and agree to fulfill these commitments throughout my participation in the group.
Download Code of Conduct
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Applicant Certification

I certify that the information supplied is accurate to the best of my knowledge. I understand the Chamber may request additional information before making a decision.
Should be Empty: