Become A Member

If you’re interesting in becoming a member of Business Networking For Locals, please reach out to Tammy Jackson so you can visit the group.

If you’ve had a chance to visit the group and would like to apply, please fill out the application below.

Applicant Information

Full Name *

Preferred Name

Business Name *

Position/Title *

Industry/Specialty *

Years In This Profession *

Years With Current Company *

Business Address *

Business Phone *

Cell Phone *

Email *

Website

Business Profile

Briefly describe your products or services: *

What distinguishes your business from others in your field? *

What geographic area do you serve? *

Membership Commitment

- Attend scheduled meetings consistently
- Provide and seek qualified referrals
- Uphold integrity and ethical business practices
- Follow all guidelines as outlined by the group leadership

Professional Reference #1

Reference 1 Name *

Reference 1 Phone

Reference 1 Email

Professional Reference #2

Reference 2 Name *

Reference 2 Phone

Reference 2 Email

Professional Reference #3

Reference 3 Name

Reference 3 Phone

Reference 3 Email

Additional Information

Have you ever been a member of a networking or leads group before? If yes, which group(s)? *

What are your goals for joining this group?

How did you hear about this group? *

Signature & Date

Type Full Name To Sign *

Date *