Membership Application Form

Personal Information

First Name*

Last Name*

Cell Phone*

Personal Email*

Preferred Mailing Address

HomeWork

City*

State*

Zip*

Country*

Name of Sponsoring Member*

Please list all boards on which you currently serve:*

Current Professional Affiliations and Achievements:*

Current Civic Community Affiliations & Achievements:*

Education Background - Institution(s) Attended/Year:*

Business Information

Title*

# of Years in Current Position*

Business Name*

Scope of Responsibilities*

Business Phone*

Specialty/Industry*

Company Type*
Large CorporationClosely-Held Business (Business has a minimum gross revenue of $3M for services or $5M in product sales)Professional Services Firm (Firm revenue exceeds $3M annually)Consultant or Sole Practitioner (Generate gross revenue exceeding $3M annually, with significant clients served)Not-for-Profit Sector (Agency serves a large number of clients and/or scope of service and has an operating budget of $3M)College or University (President, Vice President, Dean, or Director)Political Office/Government SectorCorporate Board Member

Membership Questions

Have you reviewed the membership criteria?

YesNo

Do you believe you meet the criteria?

YesNo

How did you hear about EWNJ?*

Why do you want to join EWNJ?*

I plan to be a contributing member by joining the following committee(s):*

Board AppointmentsDevelopmentFinance and InvestmentGovernanceMarketing and CommunicationsMembershipPolicyProgramsScholarshipSeat Report