[av_heading heading=’Apply for Peer 150 Membership’ tag=’h3′ style=” size=” subheading_active=” subheading_size=’15’ padding=’10’ color=” custom_font=”][/av_heading]
[av_contact email=’[email protected]’ title=” button=’Submit Application’ on_send=” sent=’Thank you for your interest in The PEER 150. We will review your application and a PEER 150 representative will contact you shortly.’ link=’manually,http://’ subject=” autorespond=’We have received your application. We will contact you shortly after reviewing your submission.’ captcha=” color=”]
[av_contact_field label=’First Name’ type=’text’ options=” check=’is_empty’ width=’element_half’][/av_contact_field]
[av_contact_field label=’Last Name’ type=’text’ options=” check=’is_empty’ width=’element_half’][/av_contact_field]
[av_contact_field label=’E-Mail’ type=’text’ options=” check=’is_email’ width=’element_half’][/av_contact_field]
[av_contact_field label=’Phone Number’ type=’text’ options=” check=’is_phone’ width=’element_half’][/av_contact_field]
[av_contact_field label=’Company’ type=’text’ options=” check=’is_empty’ width=’element_half’][/av_contact_field]
[av_contact_field label=’Title’ type=’text’ options=” check=’is_empty’ width=’element_half’][/av_contact_field]
[av_contact_field label=’Referred by (specify name and current company)’ type=’text’ options=” check=” width=’element_half’][/av_contact_field]
[av_contact_field label=’Your Industry’ type=’text’ options=” check=” width=’element_half’][/av_contact_field]
[av_contact_field label=’The long term mission of The PEER 150 is to have active and engaged members. There are many ways to achieve that goal to make The PEER 150 valuable for all members. Upon acceptance into the group, we look for our members to provide guidance and insights pertaining to membership activities and benefits and/or help in finding financial support. Is this something you are open to exploring?’ type=’text’ options=” check=” width=”][/av_contact_field]
[av_contact_field label=’Industry Accomplishments and Awards (Internal and External, Board of Director involvement)’ type=’textarea’ options=” check=” width=”][/av_contact_field]
[av_contact_field label=’Description of your job responsibility and scope in your current organization (example: budget responsibility, size of organization including direct reports)’ type=’textarea’ options=” check=” width=”][/av_contact_field]
[av_contact_field label=’What are your objectives for joining this group? What are the top three takeaways you are looking for?’ type=’textarea’ options=” check=” width=”][/av_contact_field]
[/av_contact]
