Port City Professionals Application Application Form Name * Name First First Last Last Business Name * Address * Address Address Address City City Province Province Postal Code Postal Code Business Phone * Mobile Phone * Business Website Email * What industry are you applying for? * --- Please Select One ---AccountingAdvertising & MarketingAgricultureAnimalsArchitecture & EngineeringArt & EntertainmentAutomotiveBusiness ServicesComputer & ProgrammingConstructionConsultingEmployment ActivitiesEvent ServicesFinanceFood & BeverageHealth & WellnessInsuranceLandscapingLegalManufacturingOrganizationsPersonal ServicesRepairReal EstateRetailSecuritySports and LeisureTelecommunicationsTraining and CoachingTransportationTravel Describe your products or Service (be specific) * Sponsors Full Name (must be an existing Port City Professionals member) * Sponsors Full Name (must be an existing Port City Professionals member) First First Last Last Experience & Credentials Describe your experience in your professional classification (be specific) * What is the length of time in your field of expertise? * Describe your education and certification(s). * Has your professional license ever been revoked or suspended? * Yes No Is this profession your primary occupation? * Yes No Standards & Expectations Are you able and willing to make the commitment to arrive at the monthly meetings on time and stay through the 60-90 minutes? * Yes No Do you agree to abide by the Port City Professionals membership policies and Code of Ethics? * Yes No Are you willing and able to bring referrals and/or visitors to this group? * Yes No Have you ever been convicted of an indictable offense? * Yes No Please provide details and year. Submit Application If you are human, leave this field blank.
