Jersey Village Professional Business Network Membership Application

Member Site

Please Enter as Accurately as Possible!

Your Information

Please Enter Today's Date:

Your Name:

Your Email Address:

Cell Phone Number

Yes No

Facebook (Y/N)

Yes No

Internet Social Connections

For Facebook - Go to your Facebook account in your favorite browser. I am using Chrome here, but you may use what you wish. Click on your Name (right by your picture below) the URL to your site is in the input field four the Facebook site. (See my URL highlighted in light blue below) Highlight that link and copy by clicking command + C on a Mac, and control + C on a windows machine. Go to the link form below and click on the Facebook field and command+ V on a Mac and control + V on a windows system to paste the link into the field.
You may also use the "Cut and Paste" features if you wish to cut and paste your link into the form field below.

For LinkedIn - Go to your Linked In account in your favorite browser. I am using Safari here, but you may use what you wish. Click on your Profile Button and below your picture is the link to your LinkedIn site. Highlight that link and copy by clicking command + C on a Mac, and control + C on a windows machine. Go to the link form below and click on the Linked In field and command+ V on a Mac and control + V on a windows system to paste the link into the field.
You may also use the "Cut and Paste" features if you wish to cut and paste your link into the form field below.

Facebook Link:

Linked In Link:

Employment / Company Information

Current Employer or Your Company / Corporation Name:

Website URL:

City:

Company Zip:

State:

Business Phone:

Time At Current Employer:

Position:

Describe your product or service:

Describe your Experience in your field / Occupation (be specific):

Describe your Educational background in your field/occupation. Include degrees, licenses or credentials required to perform your job.

Your Commitments

Are you willing and able to addend meetings Recularly from 11:30-1:00 on Wednesday's to build your Visibility?

Employment Status (select one)

Are you willing to comply with the Code Of Ethics and Policies?

What can we expect you to contribute to JVPNG?

What is your ability to bring qualified referrals, introductions or visitors to JVPNG?

Do you belong to other networking organizations?

Yes No

If yes, please list the organizations'

Business Rererences

Business Referral 1:

Business Referral 1 Phone Number:

List Your Contact for Business Referral 1:

Business Referral 1 Email:

Business Relationship One:

Business Referral 2:

Business Referral 2 Phone Number:

List Your Contact for Business Referral 1:

Business Referral 2 Email:

Business Relationship:

What is 9 + 7?

Meeting Location
Backyard Grill
9452 Jones Road
Houston, Tx 77065
281-897-9200
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