100 Black Men of Greater Milwaukee
Membership Application
* Required
Email address
*
Your email
Full Name
*
Your answer
Mailing Address, City, State and Zip Code
*
Your answer
Present Employer
*
Your answer
Position/Title
*
Your answer
Type of Firm/Organization
Your answer
Business Address, City, State and Zip Code
Your answer
Best Contact Number
*
Your answer
College Graduate?
Yes
No
Clear selection
If Yes, name of college/university
Your answer
Undergraduate Degree earned
Your answer
Graduate Degree(s)?
Yes
No
Clear selection
If Yes, name of college/university?
Your answer
Degree(s) earned
Your answer
Name of High School
*
Your answer
Are you an elected or appointed official?
Yes
No
Clear selection
If Yes, what is your office held?
Your answer
What board memberships do you hold?
Your answer
What organizational memberships do you hold?
Your answer
How do you believe you can benefit the organization?
*
Your answer
Please check the appropriate box regarding your referral for membership:
*
Member referral
Self-referral for membership
Required
If referred by a current member, please provide his name.
Your answer
All members of the 100 Black Men of Greater Milwaukee, Inc. are required to pay a one-time twenty-five dollar ($25.00) non-refundable application fee and $75 in dues. This fee will cover the cost of processing the application. I understand that my twenty-five dollar ($25.00) application fee is non-refundable and hereby give my consent to begin processing my application.
*
Checking this box acknowledges you have read and understand the information.
Required
I agree to and understand that in order for a thorough background check to be performed, I must provide 100 Black Men of Greater Milwaukee, Inc. with proof of acceptance as a Milwaukee Public School volunteer, or volunteer for another legitimate organization which includes a background check for affiliation, to have been completed within the last calendar year from the date of this application. All information will be kept strictly confidential. I also understand any adverse information obtained will be considered in the decision whether to accept my membership application and /or limit the scope of my activities within the 100 Black Men of Greater Milwaukee, Inc. I authorize any individual or entity to reveal to the 100 Black Men of Greater Milwaukee, Inc. the results of this criminal background check. I release the 100 Black Men of Greater Milwaukee, Inc. and any individual representative or entity from any and all claims, losses, liabilities, costs or expenses related to gathering and reporting this information.
*
Checking this box acknowledges you have read and understand the information, and you give authorization and consent for release of information to the executive board of 100 Black Men of Milwaukee, Inc.
A copy of your responses will be emailed to the address you provided.
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