Entrepreneurial Foundation of American Application

FOUNDATION BENEFITS:

By Joining The Entrepreneurial Foundation, You Will Receive:

Exclusive Membership
Eligibility For Entrepreneur Of The Year Award
A Reduced Price On Admission To Future Events
Discounts On Available Products

Annual Fee: $50

*Please note that membership dues are not deductible as a charitable contribution. A porton of your dues may be deducted as an ordinary business expense for federal tax purposes.

Please Answer All Questions & Provide Requested Information. Incomplete Applications Will Not Be Processed.

Name*

First Last

Preferred Nickname/Badge

Date Of Birth*

Social Security Number*

Organization*

Job Title*

Job Description*

Mailing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home Number*

Mobile Number*

Fax Number

Email Address*

Preferred Method Of Contact*

Send Entrepreneurial Mail To*

Telephone Preference*

Have You Ever Been Convicted Of A Felony?*

Name Of Member Who Referred You To Entrepreneurial Foundation Of America

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone Number

Are You A High School Graduate?*

ACADEMIC HISTORY - College 1:

School:

Year Graduated:

City & State:

Dates Attended:

Degree Earned:

Major:

Minor:

Certification(s):

Award(s):

ACADEMIC HISTORY - College 2:

School:

Year Graduated:

City & State:

Dates Attended:

Degree Earned:

Major:

Minor:

Certification(s):

Award(s):

ENTREPRENEUR QUESTIONS:

Please List All Awards Or Honors Received:

Please State Why You Should Be Accepted Into The Entrepreneurial Foundation Of America?*

If Accepted, Do You Already Have An Idea For A Business You Would Like To Pursue?*

What Entrepreneur Do You Admire The Most And Why?*

If Accepted, What Are The Top 3 things You Would Most Like To Learn?*

I hereby make application for membership in the Entrepreneurial Foundation of America and pledge, if accepted, to abide by the membership requirements of the association as they are now in effect, and as they may be amended. Applicant acknowledges that the use of the association logo is exclusive to members only an applicant agrees to cease utilizing the logo upon termination of membership.*

I Agree

Electronic Signature*

Please electronically sign this application by placing your initials in-between two slash symbols. For example: /ABC/

Signed By:*

Please type your full legal name.

Date*

Annual Fee:

Price: $50.00

Must be renewed annually.

Total

$0.00

Payment Information

New Payment Section

Name on Card*

First Last

Card Number*

Card Number

Expiration Date*

Expiration Date

Security Code*

Security Code

Bank Name*

Bank Name

Name on Account*

Name on Account

Bank Routing Number*

Bank Routing Number

Bank Account Number*

Bank Account Number

Credit Card*

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Billing Address*

Street Address Address Line 2 City State ZIP Code

Total

$0.00