Rising Tide Membership Application Your name Date Your email Your cell phone Business name Business Phone 1) Experience in Field/Occupation? What services or products do you most deliver? 2) Education background in field/Occupation or degrees/credentials: 3) How long have you been with the company and industry/profession you are representing today? 4) What are your goals and expectations related to joining Rising Tide? 5) What do you expect to contribute to the group? 6) List two people and their industry/profession (local) that you’d most like to be introduced to: 7) List your three primary referral sources and the industry/profession each is in: 8) Do you belong to other networking organizations? If so, please list: Please list Business References: Reference 1: Name Position Business Business Relationship Business Phone Reference 2: Name Position Business Business Relationship Business Phone I hereby declare and certify that all statements contained in this application and any accompanying documents are true and accurate.
