Request edit access
NECINA E-Club Application Form
NECINA Entrepreneur Club (E Club) is a community of technology founders and executives. If you are or have been a founder, owner or executive of a technology business, we welcome you to join us. Please complete the form below to apply.
Email *
Your answer
Name *
Your answer
Phone # *
Your answer
Linkedin Profile
Your answer
Are you an active NECINA Member *
Company Name *
Your answer
Your Job Title *
Company Website *
Your answer
Please use one sentence to describe your company's main business activity *
Your answer
Please select your target market
Please select the areas of your business that you hope E-Club can help
Please select the E-club activities you would be interested in
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service