Proposal for Membership Form

Recommending Member
Recommending Member Email Address
Phone Number
Fax Number
Date
Date Format: MM slash DD slash YYYY
Person Recommended
Name
Title
Company
Location
Phone Number
Fax Number
Email
Address
Street Address City State / Province / Region ZIP / Postal Code Country
How do you know one another?
- Personal
- Business
- Both
- Other
How long known?
Does the recommended party meet all Intellenet Requirements?
See By-Laws and Code of Ethics
- Yes
- No
Please provide a brief narrative explaining the following: Has the candidate expressed a desire to be a member of Intellenet?
If the proposed member is located in an area where we have coverage, why would that member be an asset to Intellenet? Are there any other factors you would like to mention? (i.e., Expertise, Specialities, Special Connections or knowledge).
Name
This field is for validation purposes and should be left unchanged.