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Membership Application Form

All fields marked with an asterisk (*) are required

*Mobile:
*Email:
*Date of Birth:(dd-mm-yyyy)
*Spouse’s Name:
*Name(s) and Age of Child(ren):
*Telephone:
*Residence Address:
Assistant Name:
Assistant Telephone:
Assistant Mobile:
Assistant E-mail:
*Company Name:
*Designation:
*Company Address:
*Company Description:
*Year of Establishment:
*What % of the company do you personally own?
*Parents / Spouse / Children
Type of Company
Private Publicly Listed
Is this company a division of a larger company?
Yes No



*Number of Full-Time Employees:
*Gross Revenue in Last Fiscal Year (INR)
*Net Profit in Last Fiscal Year (in INR)
*Key Responsibility Area’s (Please Elaborate):
*Significant Achievements:
*Company Duration:

If you are an interested Director of more than one corporation, please give the information below for each corporation, eliminating duplication of sales volume and number of employees from inter-corporate transactions.

Company Name(s):

Number of Full-Time Employees OR Total Annual Compensation of all employees, excluding applicants:

Gross Sales Volume or Total Billings for most recent year (Month) (year) ending:

Please list any groups or organizations (formal or informal), the main purpose of which is to exchange ideas, to which you belong:

Please list any groups or organizations (formal or informal), the main purpose of which is to exchange ideas, to which your spouse belongs:

Would you consider yourself skilled enough in a particular field or endeavour to be called upon to make a formal presentation during one of our membership meetings? If Yes, indicate fields.

To what societies, clubs or professional organizations do you or your spouse presently belong? Please indicate any leadership positions you or your spouse have held. (Self-Position-Organization/Spouse-Position-Organization:

Self-Position-Organization
Spouse-Position-Organization

Education:
*High School & Course:
*High School Duration:
*Undergraduate School & Course:
*Under Graduate Duration:
*Post Graduate School & Course:
*Post Graduate Duration:

Spouse’s Education:
High School & Course:
High School Duration:
Undergraduate School & Course:
Under Graduate Duration:
Post Graduate School & Course:
Post Graduate Duration:

Your Previous Work Experience:
Company Name
Designation
Nature of Roles & Responsibilities (describe in brief):
Duration:

Company Name
Designation
Nature of Roles & Responsibilities (describe in brief):
Duration:

Two Personal References:
Name
Email
Mobile:
Relationship with you:

Name
Email
Mobile:
Relationship with you:

Please list your hobbies in order of preference:

Please list your spouse’s hobbies in order of preference:

In what functional area(s) (marketing, finance, etc.) would you describe yourself as having the most expertise?

If you had to introduce yourself to the EO Gurgaon peer group in one paragraph, what would that be? (Think through this! If you are accepted to the Organization, this will be your introduction message)

Have you applied to EO Before?
Yes No
if "yes" please specify the chapter and year applied in.

Upon receipt of your application, the Membership Chair may contact these references. Thank you for your time in completing this application. I certify that all information contained in this application is correct and I understand that if approved, I will be required to complete a formal application for EO membership.

Please note: Incomplete forms and submissions without complete disclosure are prone to being rejected by the EO Gurgaon Board. We strongly encourage you to spend time in completing this pre-application form if you are sincere in your application for membership

To apply for EO Gurgaon Membership
Download EO Gurgaon Membership Form

EO Gurgaon Revenue Verification Form
     
EO Gurgaon Membership Application Form



Please email this filled application form to

admin@eogurgaon.com       support@eogurgaon.com      raunaq@targustech.com