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Personal Information
First Name
Last Name
Email
Phone
Title
Education
Referred By
Date Of Birth
Sex
Male
Female
Married
Yes
No
Total Entrepreneurial Experience
Spouse Name
Spouse DOB
Children Details
Mention Name and DOB
Do you have children helping your business or running their own business?
Yes
No
If the children helping your business or running their own business describe it
Profile Picture
Drop image file here or click to upload
Contact Information
Personal Address
Personal Landline
Business Email
Business Address
Business Fax
Business Landline
Preferred Contact Address
Personal Address
Business Address
Company Information
Name Of Company
Year Of Establishment
Number Of Employees
Family Business
Yes
No
Approximate Annual Turnover
Projected Turnover For 5 Years
Business Sector
Company URL
Description Of Services/Products
Please describe your vision for your company
Membership Expectations
What expectation do you have from this membership?
Would you be interested to enhance your leadership skills by attending seminars/conferences/courses etc?
Yes
No
Commitments
How many hours can you spend for this club in a calendar month?
3 to 5
5 to 8
More than 8
Would you be able to participate in annual family retreats?
Yes
No
Would you be interested in attending international events?
Yes
No
Would you be interested to participate in mentorship programs?
Yes
No
Entrepreneurial Outlook
Describe yourself as a leader?
How do you give back to the society?
Please specify other information that you would like to share
Are you member of any other professional clubs/associations? (Do not include social clubs/associations)
Yes
No
If you are a member of any other professional clubs/associations Please specify.
Prior/existing positions in the above clubs/associations?
Describe your contribution to business community ?
Please list your interests/hobbies in detail: (Related to charitable/spiritual/cultural/social)
Achievements and awards (Professional and organisational)
Date
Place
×
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