BNI Alberta South | Membership Application Form

Basic information

Please pay special attention to spelling as you enter the information below.
Upon your acceptance to BNI, this information will be shown on your membership record as entered.

1. Which BNI Chapter are you applying to join? *This question is required.

Forming Chapter, please specify: *This question is required.

2. Your First Name *This question is required.

3. Your Last Name *This question is required.

4. Email *This question is required. This question requires a valid email address.

5. Profession *This question is required.

6. Describe Your Product or Service *This question is required. This should be a brief but specific explanation. This will be part of your BNI Member Profile.

7. Business Name *This question is required. Please enter exactly as this should be shown on your Member Profile or printed on your name tag (below your name).

8. Business Address *This question is required.

Street
City
Postal Code

9. Business Phone *This question is required.

10. Cell Phone *This question is required.

11. Website

12. Your Personal Facebook Profile URL e.g. https://www.facebook.com/john-doe
We will invite you to a Member-Only Facebook Group.
Please be prepared to accept a Facebook friend request from Moji Ajele, BNI Alberta South Executive Director.

13. Sponsor's Name The name of the person who was the first to invite you to BNI (if applicable).

14. I have a Certificate of Credit from when I was a BNI Member in the past *This question is required.* The Certificate of Credit is issued via email to Members in good standing who resign their membership more than a month before their renewal date.
Upon acceptance to the Chapter, please forward this Certificate of Credit to our Regional Office and you will be credited on your BNI Membership.