BUSINESS RESOURCE NETWORK APPLICATION

First Name :
Last Name :
Company :
Email Address :
Street Address :
City: State: Zip Code:
Phone Number :
Fax Number :
Website Address:

What Product(s) / Service(s) do you provide?

What Industry do you want to be represented as?

What do you expect from our group?

What can the group expect from you?

Are you willing to share your current clients with other members in our group?
Yes No

Are you willing to commit yourself to others in this group by meeting with other members outside of the morning meeting consistently?
Yes No