Online Membership Application

HABNET MEMBERSHIP FORM
    Business Information
  1. Business Name*
    Please let us know your name.
  2. Contact Person*
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  3. Products/Services*
    Please let us know your Products or Services.
  4. Email*
    Please let us know your email address.
  5. Website
    Do you have a website? what is the address.
  6. Address*
    Street Address.
  7. City*
    City.
  8. State*
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  9. Zip Code*
    Zip.
  10. Cell/Office Phone*
    Phone or Cell.
  11. Fax
    Phone or Cell.
  12. Membership Level
  13. Please include membership fee

    (select one)*





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  14. Available to College Students and some High School students. They are offered a special introductory rate significantly below that of regular members and the following support services:
    • ◆ Eligible for the Young Entrepreneur Citizen Program and Mentorship
    • ◆ Eligible for the Young Adult Management Program
    • ◆ Free admission to FOUR HABNET Networking Events per year
    • ◆ Counseling and Assistance when starting their business
  15. Available to Individuals, Professionals, and current/prospective Entrapreneurs who do not own a business, but are largely responsible for their own income production.
    • ◆ Eligible for all the Member Benefits on the right
  16. Available to Small Business Owners with one or more employees.
    • ◆ Eligible for Technical Assistance from NYC Business Solutions and HABNET
    • ◆ Eligible for all the Member Benefits on the right
    • ◆ Have opportunity to serve on the Board of Directors & Executive Committee
    • ◆ Eligible for ONE free ticket to all paid HABNET Events
    • ◆ Member Highlight in our quarterly electronic Newsletter
    • ◆ Free Exhibitor Table to HABNET Networking Events
    • ◆ Eligible for all the Member Benefits on the right
    • ◆ Have opportunity to serve on the Board of Directors & Executive Committee
    • ◆ Have the option to Chair relevant Committees
    • ◆ Eligible for TWO free tickets to all paid HABNET Events
    • ◆ Member Highlight in our quarterly electronic Newsletter
    • ◆ Free Exhibitor Table at HABNET Events
    • ◆ Eligible for all the Member Benefits on the right
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  22. Total due
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  23. Business Needs
  24. Number of Years in Operation
    Number of years.
  25. Estimated Annual Revenue $
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  26. What are the current needs of your business?




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  28. Is your business M/WBE Certified?
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    Volunteer Committees
  1. On which committee do you prefer to serve?

    (Select no more than two)








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  2. Days and Time you are available to volunteer

    (check all that apply)








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  3. Time of the day
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  4. Credit Repair Service
  5. Please fill out a separate application if you elect to receive credit repair service
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    Disclaimer
  1. HABNET DISCLAIMER - I understand that The Haitian-American Business Network (HABNET Chamber of Commerce) also serves as a referral service designed to minimize the costs associated with various services for our members and affiliates. I understand that each participant of the Business Network is a distinct entity that operates independently from HABNET. I will not hold HABNET or any of its officers liable in any way or form for any and all actions performed by participants (organizations or individuals) of the Haitian-American Business Network Chamber of Commerce.
  2. (Agreement is a condition of membership)*
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  3. LEADERSHIP AND SERVICE PLEDGE- As a Member/Officer of HABNET Chamber of commerce, I do solemnly affirm that I will administer my duties and conduct my business with integrity and honesty; that I will promote an environment of mutual respect and fraternity; that I will provide leadership and service in a manner that will have a positive impact on my community. I take this obligation freely, without any mental reservation or purpose of evasion. So help me God.
  4. Signature*
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  5. Date
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  6. Submit
  7. Please type verification characters before submitting
    Please type verification characters before submitting
      RefreshInvalid Input
  8.   

PDF Membership Application

The form below is interactive, please type your information on the form and print it using the appropriate icon below. Send the completed form, along with a check made payable to HABNET with the amount of the membership selected to our office located at 1401 Flatbush Avenue, Suite 203 Brooklyn, NY 11210. Thank you.

altClick here to download form, type your information and print the Membership Application in PDF.

2016application

Online Board of Directors Application

Board of Directors Application
  1. Last Name* Please let us know your name.
  2. First Name* Invalid Input
  3. Email* Please let us know your email address.
  4. Street Address* Do you have a website? what is the address.
  5. City* City.
  6. State* Invalid Input
  7. Zip Code* Zip.
  8. Home Phone Phone or Cell.
  9. Business Phone* Phone or Cell.
  10. Cell Phone Invalid Input
  11. Highest level of education completed (select one):
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  12. If you are currently a student, please indicate the following:
    Name of institution attending
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  13. Major
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  14. Expected date of completion
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  15. Field(s) of expertise/special skill(s)
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  16. Are you currently serving in a leadership capacity in any not-for-profit organization?
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  17. If yes, please indicate Name of Institution
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  18. Board Member Annual Dues
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  20. Other Amount
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  21. Answer YES or NO to Questions 1-7. If your answer is “YES” to any question, please explain.
  22. 1. Do you currently owe any child support? *
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  23. 2. Have you ever had any professional certificate or license denied, revoked, or suspended?*
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  24. 3. Have charges ever been brought against you by an employer?*
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  25. 3B. If yes, were you found guilty of the charges?*
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  26. 4. Did you ever receive a discharge from military service that was issued under other than honorable circumstances?*
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  27. 5. Is there anything in your past if made public would embarrass this institution?*
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  28. Falsifying an application is ground for dismissal and your termination.
  29. HABNET DISCLAIMER - I understand that The Haitian-American Business Network (HABNET Chamber of Commerce) also serves as a referral service designed to minimize the costs associated with various services for our members and affiliates. I understand that each participant of the Business Network is a distinct entity that operates independently from HABNET. I will not hold HABNET or any of its officers liable in any way or form for any and all actions performed by participants (organizations or individuals) of the Haitian-American Business Network Chamber of Commerce.
  30. (Agreement is a condition of membership)*
    Invalid Input
  31. LEADERSHIP AND SERVICE PLEDGE- As a Member/Officer of HABNET Chamber of commerce, I do solemnly affirm that I will administer my duties and conduct my business with integrity and honesty; that I will promote an environment of mutual respect and fraternity; that I will provide leadership and service in a manner that will have a positive impact on my community. I take this obligation freely, without any mental reservation or purpose of evasion. So help me God.
  32. Signature*
    Invalid Input
  33. Date*
    Invalid Input
  34. Please type verification characters before submitting*
    Please type verification characters before submitting
      RefreshInvalid Input
  35.