SWJOCO Referral and Networking Group Application

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SWJOCO Referral and Networking Group Application

Thanks for considering becoming a member of the Southwest Johnson County Referral and Networking Group. After completing this application a member from the membership committee will contact you. A recommendation to the Executive Committee will not be issued until the Membership Committee completes their review. Please be prompt in responding when a member of the membership committee contacts you. Items with an asterisk are required. * Required

Part 1
Applicant's Contact Information 1. Your Business Address is *

2. Your Business Name *

3. The city, state and zip of your business is * Example: Gardner, KS. 66030

4. The phone number of your business is * Example 913-999-9999

5. Your name is *

6. Your home address is *

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7. The city, state and zip of where your home is * Example: Gardner, KS. 66030

8. Your home number is Example: 913-999-9999

9. Your mobile number is * Example: 913-999-9999

10. Your email address is * Example: Test@Test.com

11. Your Facebook address is Example: http://www.Facebook.com/Test

12. Your Google+ address is Example: https://plus.google.com/SeriesOfNumbers/about

13. The web address of your website is Example: http://www.Test.com

Part II
Application Process. Please read carefully and check the box after reading each line.

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14. Application Process * Check all that apply. An application will only be reviewed after the applicant has attended 2 meetings. All applications will be reviewed by the membership committee All applicants will provide answers truthfully Applicants will respond to the membership committee promptly The President will announce new members at the next meeting

Part III
Education and Background Information 15. What Field/Occupation do you want to represent in SWJOCO Referral and Networking Group? * Example: Roofing Contractor, Real Estate Agent, Banker, Insurance, Mortgage Loan Officer

16. What experience do you have in your Field/Occupation? * (Please be specific and include how many years of experience)

17. What degrees, licenses or credentials do you have for your position you are seeking to represent in the group? *

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18. Do you have all necessary degrees, licenses or credentials to preform your business? * Mark only one oval. Yes No 19. Is your position you are seeking in the group a full time or part time position? * Mark only one oval. Part Time Full Time 20. Are you the main contact for members of the group to contact to refer business to? * Mark only one oval. Yes No 21. How long have you been in the occupation with the company you are representing? *

Part IV
Expectations and Goals 22. Are you willing to make a commitment to arrive at our weekly meetings on time and stay during the duration of the meeting? * Mark only one oval. Yes No 23. Are you willing to help grow the group and bring qualified referrals? * Mark only one oval. No Yes

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24. Do you have a substitute visitor planned in case you need to miss a weekly meeting? * Mark only one oval. No Yes 25. What do you expect to contribute to the group? *

26. What is your ability to bring qualified referrals, visitors and schedule one-on-ones? *

27. Do you belong to any networking organizations? * Mark only one oval. Yes No 28. If yes to the above question, please list the groups you belong to?

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29. Please list any members or businesses you can not refer to in Gardner: * (If none, type in none)

30. How many years have you been doing business in Gardner? *

Part V
Business References 31. Name of Business Reference 1 *

32. Name of business and position within the company *

33. Phone number of business reference 1 * Example: 913-999-9999

34. Personal/Business relationship with reference 1 *

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35. Name of Business Reference 2 *

36. Name of business and position within the company for reference 2 *

37. Phone number of business reference 2 * Example: 913-999-9999

38. Personal/Business relationship with reference 2 *

39. Name of Business Reference 3 *

40. Name of business and position within the company for reference 3 *

41. Phone number of business reference 3 * Example: 913-999-9999

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42. Personal/Business relationship with reference 3 *

Part V
Resume, biography and additional information can be sent to any member of the Membership Committee. 43. Statement: I have answered the questions honestly. * Mark only one oval. Yes Somewhat No 44. I would like to add: (Please add any information you would like the membership committee to consider in reviewing your application)

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