INTELLENET

P.O. Box 350

Gladwyne, PA 19035

PROPOSAL FOR MEMBERSHIP FORM

ONLY ACTIVE INTELLENET MEMBERS MAY USE THIS FORM.
Other inquiries should be emailed to intellenet@intellenetwork.org.

Approved 07/08/04


Recommending Member: _________________________   Date:__________________
Recommending Member Email Address: ____________________________________
Telephone: ___________________________    Fax:____________________________


Person Recommended:


Name: _______________________________           Title: _________________________


Company_____________________________     Location: _________________________

 

Telephone____________________________     Fax: _____________________________

 

Email Address: ___________________________________________________________

 

Mailing Address: _________________________________________________________

 

_______________________________________________________________________

 

_______________________________________________________________________


How Known (Personal, Business, Both, Other)?_________________________________

How Long Known? ______________ 

Does Recommended Party meet all INTELLENET Requirements (See By-Laws and
Code of Ethics)? __________________________________________________________

Please provide a brief narrative explaining the following: Has the Candidate expressed a desire to be a member of INTELLENET? If the proposed member is located in an area where we have coverage, why would that member be an asset to INTELLENET? Are there any other factors you would like to mention? (i.e. Expertise, Specialties, Special Connections or knowledge).


Submit the completed form to the Executive Director by: E-mail to intellenet@intellenetwork.org  or MAIL to INTELLENET , PO Box 350, Gladwyne, PA 19035

Thank you.