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Apex Networking Application
Name
(Required)
First
Last
Email
(Required)
Business Phone
(Required)
Mobile Phone
(Required)
Business Name
(Required)
Industry/Field (ie, Financial Advisor, Credit Card Processing)
(Required)
Address
(Required)
Street Address
City
State / Province / Region
ZIP / Postal Code
Website
Apex Sponsor's Name
How did you find us?
Background
Years of Experience in Field
(Required)
Educational Background in Industry, Including Certificates and Licenses
(Required)
Is this your primary occupation?
(Required)
Yes
No
Expectations
Are you willing and able to meet the attendance policy for Apex Networking, and find substitutes when necessary?
(Required)
Yes
No
Are you willing and able to find referrals and bring visitors in accordance with the Apex Networking requirements?
(Required)
Yes
No
Do you belong to another networking group that requires exclusive membership rules? (NOTE: groups like a Chamber of Commerce do not have exclusivity requirements)
(Required)
Yes
No
Are you willing to abide by the established Code of Ethics?
(Required)
Yes
No
Do you agree to adhrere to the rules and regulations of Apex Networking as written in the Policies and Procedures of the organization?
(Required)
Yes
No
Have you ever been convicted of a felony?
(Required)
Yes
No
References
Please provide two professional references. Please do not use employees or family members.
Name Reference #1
(Required)
First
Last
Company Reference #1
(Required)
Relationship to Reference #1
(Required)
Phone Reference #1
(Required)
Name Reference #2
(Required)
First
Last
Company Reference #2
(Required)
Relationship to Reference #2
(Required)
Phone Reference #2
(Required)
I agree that this information is accurate and valid, and that Apex Networking membership committee may contact my references for the purposes of verifying eligibility.
(Required)
I Agree
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