Name of Applicant *

Phone

Email Address

Name of Business

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

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Job Title / Description

Length of time in this position:

Length of time in industry:

What is your Business Category/Classification?

Are you actively involved in the running of any other businesses? Do you hold any other corporate positions/jobs?

Professional Organizations you belong to:

Networking Organizations you belong to:

Have you been involved with other networking groups? For how long?

Describe any leadership roles you have taken in other groups:

Business Categories to whom you feel you can refer the most business:

Business Categories you see being the most beneficial for you:

What are your expectations from the Golden Triangle Executives Association group?

Do you feel you can meet that time obligation on a regular basis? *YesNoThe group meets every Thursday, from 11:45 am to 1:00 pm (4 Thursdays/month).

What aspect of the group do you feel you can best contribute? (rate from 1 to 4 )

Taking leadership roles1 – First Choice2 – Second Choice3 – Third Choice4 – Fourth Choice

Providing quality services at a fair price for referrals received1 – First Choice2 – Second Choice3 – Third Choice4 – Fourth Choice

Providing referrals to group members1 – First Choice2 – Second Choice3 – Third Choice4 – Fourth Choice

Bringing new members to the group1 – First Choice2 – Second Choice3 – Third Choice4 – Fourth Choice

Would you be comfortable referring your clients, friends, family members to other members of the group on a regular basis?YesNo

Are you a former GTEA Member?YesNo

Who referred you to GTEA?

Which GTEA members do you know?

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