Network In Action

NIA Group

Applicant Full Name *

Application Date *

Anniversary Date *

Company Name *

Address

Street Address

City *

State *

Country

Postal Code

Phone *

Email *

Website *

Primary Focus *

Networking

Coach me up

Are you willing to commit to attend our monthly meeting, arrive on time and stay for the 90 minutes, make referralswhen appropriate, and abide by NIA policies, guidelines and code of ethics? *

Yes

No

I understand that I am committing to a 12 month period. *

Yes

No

If you check "Networking", are you willing to pass 12 referrals over the next year? *

Yes

No

Which seet are you applying for? Please be very specific. (Ex: residential realtor) *

If you checked "Coach Me Up," please select 3 of the 10 options for the areas you wish to develop. *

I understand that both a business assessment and background check is required. *

Yes

No

Applicant Signature *

Clear

Date Signed *

Membership Fee

Application Fee: $200

Annual: $2,000

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Total $2,200

Monthly: $200

•Must agree to 12 month commitment

•Return this application to your community builder.

•Make checks payable to Tactical Business Solutions

Payment *

$ 200

$ 2000

$ 2200

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