Membership Application

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Membership:

Executive Membership ($500) - Enhanced benefits for increased visibility and access

Professional Membership ($150)

General Membership ($50)

Professional Membership for employees of platinum corporate investors ($100)

Young Professional 6 month Membership ($35) - One time use only. For individuals 18 - 33 years of age

Region Referred By: Create a Login Name: Login Password: Retype Password: Prefix: First Name: Middle/Initial: Last Name: Suffix: Title: Company: Address Type: Address: City: State: Country: Zip Code: - Phone: Type: Phone 2: Type: Email: Email 2:

Demographics

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Industry Occupation: Ethnicity (select one or more):

African American

Arab American

Asian American

Caucasian

Hispanic

Native American

Pacific Islander

Other

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Student Members ONLY

Student Membership is available for full-time students currently enrolled at a university or college.

University or College: Degree or Area of Study: Expected Graduation Date:

Executive Members ONLY

Executive Members receive additional visibility and recognization. Please complete the questions below.

Web Site: Business Mission Educational Background Memberships, Board Positions, Etc. Her Personal Side Most People Don't Know Something You Should Know Words of Wisdom

Communications

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Region:

Southeast Michigan

West Michigan

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