Level of Interest(Required)Select One1 - I want to be part of this today!2 - I'm interested but need to talk to someone first.3 - Now is not the time.For Existing Members Only: Renew Membership Change Classification Change Member Change Chapter Application Form Part 1: Personal and Business Information BNI Chapter Who invited you to BNI? Applicant Name First Last Position Email Business Phone Home Phone Business/Company Name Website Correspondence or Business Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Describe your product or service. Please be specific. Part 2: Education and Experience Experience in Field/Occupation. Please be specific. Educational Background in field/occupation, degrees, licenses or credentials required to perform in field/occupation: Part 3: Additional QuestionsIs the occupation under which you are applying for participation Full-Time Part-Time? How long have you been with the company you are representing today? Please answer in years.Are you able and willing to make the commitment to arrive at our weekly meetings no later than 7:00 AM and stay until 8:30 AM, and to attend training within within 6 weeks if accepted as a participant? Yes No Is there an individual in your company who would be willing and able to attend meetings on your behalf, should you be unable to attend? Yes No What do you expect to contribute to this chapter? Give Business Introduce Clients/Prospects Others If Others, please specify. What is your ability to bring qualified leads or visitors? Poor Fair Excellent Have you ever been a member of BNI? Yes No If so, which chapter? Do you belong to any other networking organizations? Yes No If so, please list.Are you an undischarged bankrupt or have you been convicted of an offense involving dishonesty? Yes No Part 4: Business ReferencesBusiness Reference #1Full Name Business Name Phone Number Business Relationship Business Reference #2Full Name Business Name Phone Number Business Relationship Part 5: Membership Fee Revised Fees Starting April 1, 2023 1-year Membership P43,500 Membership Fee: P31,320.72Research and Dev.: P1,715.00Participation Fee: P5,803.57Sub-Total: P38,839.29VAT: P4,660.71Total: P43,500.00Savings: P37,124.29 2-year Membership P73,000 Membership Fee: P61,748.57Research and Dev.: P3,430.00Participation Fee: P5,803.57Sub-Total: P65,178.57VAT: P7,821.43Total: P 73,000Savings: P7,500 1-Year Membership Renewal P37,000 Membership Fee: P31,320.71Research and Dev.: P1,715.00Sub-Total: P33,035.71VAT: P3,964.29Total: P37,000.00Savings: P31,320.71 2-Year Membership Renewal P66,500 Membership Fee: P55,945.00Research and Dev.: P3,430.00Sub-Total: P59,375.00VAT: P7,125.00Total: P 66,500Savings: 7,500 Late Fee: P3,500Administrative Policies #3: Within 15 days after the due date. After 15 days it will be considered as a new application Admin Fee: P3,500Change Representative / Change Classification Desired Payment Method Cash Cheque Online Payment Please make cheques payable to: Referral Partners Inc. Security Bank Checking Account No.000-023735-853Bank Name Cheque No. Desired Payment Method (Membership Fee to be settled only upon approval of application) Cash Cheque Online Payment Data Consent AgreementBy submitting this form, I confim that all details are true and correct, and I agree to be bound to the terms and conditions of this application and by the policies of BNI (which includes Code of Ethics) as the may be amended from time to time. I understand that the information provided will be used by BNI Business Solutions, Inc. in connection to my application and membership. This information shall be stored and used in a manner consistent with applicable data privacy laws and regulations, including the European General Data Protection Regulation (GDPR), and the Data Privacy Act (DPA) of 2012.All the information that you have provided in relation to this form shall be protected with reasonable and appropriate measures, and shall only be retained as long as necessary in its processing. For more information on how we process your personal information, please refer to: https://www.bni.com/privacy-policyConsent(Required) I consent to the terms stated above under Data Consent Agreement. I do not consent. CommentsThis field is for validation purposes and should be left unchanged.