Influential BWN Application
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What Chapter Are You Applying For? *
Name *
Email Address *
Cell Phone Number *
Name of Your Company *
Are you the owner of the company? i.e. not a 1099 employee or a member of the leadership team
Clear selection
How many employees do you have? (1 required)
What is your industry? Please be super specific on all areas that you serve as we only allow one person per industry and need the full scope of work when reviewing applications. 
Are you a brick and mortar? 
Clear selection
Are you the primary decision maker? i.e. hiring, spending, growth initiatives, HR etc.
Clear selection
Is your company registered with the Secretary of State?
Clear selection
Provide your EIN number *
How many years have you owned this business? (2+ years required) *
Is your business your full time job and your primary source of income? (Required) *
Does your business generate more than $50,000 in revenue annually? *
Do you belong to other networking groups? *
What do you expect to gain from this group? *
What can we expect from you as a contributing member of the group? *
How did you hear about Influential BWN? *
What is your Instagram Handle? *
What is your business website?
Can you commit to 2 meetings per month?
Baton Rouge, Wednesdays 8:30-9:30
Central, Thursdays 9:30-10:30
 *
Can you commit to quarterly dues of $250/quarter? *
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