Board of Directors Application
  1. Last Name
    Please let us know your name.
  2. First Name
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  3. Email
    Please let us know your email address.
  4. Street Address
    Do you have a website? what is the address.
  5. City
  6. State
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  7. Zip Code
  8. Home Phone
    Phone or Cell.
  9. Business Phone
    Phone or Cell.
  10. Cell Phone
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  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)
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  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
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  33. Date
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  34. Please type verification characters before submitting
    Please type verification characters before submitting
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  • 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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