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Memebership Application Form

Nickname:
Date of Birth:(dd-mm-yyyy)
Spouse’s Name:
Name(s) and Birthdate(s) of Child(ren)
Company Name and Address:
Telephone: Cell: Fax: E-mail:

Assistant’s Name:
Telephone: Fax: E-mail:
Designation:
Company Description:
Residence Address:
Telephone: Fax: E-mail:
Type of Company: (Please tick)
Private Publicly Listed
Division of Larger:
Yes No
Your % Ownership: 100
Yes No

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

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

Gross Sales Volume or Total Billings for most recent year (mo) (year) Ending:

1. 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.

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

3. Would you consider yourself skilled enough in a particular field or endeavor to be called upon to make a formal presentation during one of our membership meetings? Yes No If Yes, indicate fields.

4. 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 / Spouse Organization Position

5. Is an EO member in any corporation affiliated with or related to your own company? Yes No

6a. Your Previous Work Experience:

Company Name:

Position:

Duration:


6b. Your Education:


High School:

Duration:

College(s):

Duration:

From:

To:


Graduate School:

Duration: 1 Year

From:

To:


7. Please list your hobbies in order of preference:

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

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

10. Please list two personal references below:

Name Address & Telephone Relationship to You

Name Address & Telephone Relationship to You

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 preliminary application is correct and I understand that if approved, I will be required to complete a formal application for EO 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