Board of Directors Application

Last Name
Please let us know your name.

First Name
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Email
Please let us know your email address.

Street Address
Do you have a website? what is the address.

City
City.

Zip Code
Zip.

State
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Home Phone
Phone or Cell.

Business Phone
Phone or Cell.

Cell Phone
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Highest level of education completed (select one):
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Please Specify
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If you are currently a student, please indicate the following:
Name of institution attending
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Major
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Expected date of completion
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Field(s) of expertise/special skill(s)
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Are you currently serving in a leadership capacity in any not-for-profit organization?
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If yes, please indicate Name of Institution
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Other Amount
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Answer YES or NO to Questions 1-7. If your answer is “YES” to any question, please explain.
1. Do you currently owe any child support?
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Explanation for Question 1
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2. Have you ever had any professional certificate or license denied, revoked, or suspended?
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Explanation for Question 2
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3. Have charges ever been brought against you by an employer?
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Explanation for Question 3
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3B. If yes, were you found guilty of the charges?
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Explanation for Question 3B
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4. Did you ever receive a discharge from military service that was issued under other than honorable circumstances?
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Explanation for Question 4
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5. Is there anything in your past if made public would embarrass this institution?
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Explanation for Question 5
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Falsifying an application is ground for dismissal and your termination.
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.
(Agreement is a condition of membership)
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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.
Signature
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Date
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Please type verification characters before submitting
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WELCOME TO HABNET

MEMBER BENEFITS

  • Certificate of Membership and HABNET Pin
  • Password Access to online HABNET Membership Directory, Webinars and Archives
  • Business to Business and General Referral Service at Discount Prices
  • Mentoring and Training of Prospective Business Owners
  • Invitations to all HABNET’s Monthly Education & Networking Sessions
  • Staffing via Internship and Job Placement for College and High School Students
  • HABNET Member Scholarship for Outstanding Students
  • Resources for Financial Literacy, Business Education and Development
  • Sources of Financing Referral for Members
  • Complimentary Assistance with M/WBE Certification Application
  • Collaboration for Business Ventures and Investments
  • Advertising in E-Newsletter, Website, Directory and Other Media
  • Incentive for Excellence: HABNET Entrepreneur of the Year Award
  • Civic Engagement through HABNET’s Government Affairs Committee

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