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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 Address Line 2 City State / Province / Region ZIP / Postal Code Country

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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