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Business Category

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Application For Membership

The objectives of the Executives’ Association of New York City are to institute and maintain a continuous interchange of business information among its members in a setting that promotes friendship, encourages cooperation, fosters improved efficiency and service, expands business opportunities and aids each member to grow within its own local, national and foreign markets. Membership is open to companies, firms, and organizations. For ease in completing this application, all entities are referred to as “companies.”

Click here for current dues information.

Please note that EANYC bylaws preclude a designated representative from belonging to another formalized networking group. However, Vistage, EO, YPO, and Industry Trade Groups are allowable.

APPLICATION FEE*

APPLICATION FEE (NON-REFUNDABLE) - $250.00 USD

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Choose Payment

Pay via Credit Card

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APPLICATION TOTAL:*

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ABOUT YOUR COMPANY

NAME OF COMPANY AND ANY D/B/A:*

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APPLICATION DATE:*

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BUSINESS DESCRIPTION:
What is the company’s primary business?*

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BREAKDOWN OF BUSINESS:
What other business activities does the company engage in? (Please provide the percentage of revenues from each business activity the company engages in)*

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Company Address*

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City*

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Company Phone Number*

Please enter a valid phone number

State*

Please choose your company state

Website*

Please enter a website URL starting with "http://" or "https://"

Zip Code*

You must enter a valid five digit USA zipcode.

MEMBER REPRESENTATIVE INFORMATION

First Name*

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Last Name*

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DATE OF BIRTH

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Home Address

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City

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Direct Email*

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State

Please choose your home state

Direct Phone Number*

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Zip Code

Please enter a valid US zip code

DUTIES AND RESPONSIBILITIES*

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PERSONAL AUTHORITY IN COMPANY*

IN GOVERNANCE

IN STRATEGY PLANNING

IN HIRING AND DISCHARGING

IN OPERATIONS

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EDUCATION*

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HOW MANY EMPLOYEES REPORT TO YOU?*

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START DATE AT COMPANY*

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HOBBIES, INTERESTES AND PHILANTHROPIC INVOLVEMENT

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OTHER PROFESSIONAL EXPERIENCE

PREVIOUS EMPLOYMENT (Name, address and number of years with company)*

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PROFESSIONAL CERTIFICATIONS & EDUCATION*

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LIST ANY OTHER MEMBERSHIPS HELD OR NETWORKING ASSOCIATIONS. (INCLUDE ANY OFFICE POSITIONS HELD)

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Sponsor Information

IS THERE A SECOND SPONSOR:

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PROSPECTIVE LEADS & CLIENTS

LIST TEN INDIVIDUALS YOU KNOW PERSONALLY AND CAN RECOMMEND AS PROSPECTIVE LEADS TO OTHER MEMBERS: (Company & Contact)

1. NAME:*

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2. NAME:*

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3. NAME:*

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4. NAME:*

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5. NAME:*

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6. NAME:*

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7. NAME:*

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8. NAME:*

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9. NAME:*

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10. NAME:*

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COMPANY:*

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COMPANY:*

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COMPANY:*

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COMPANY:*

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POSITION:*

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POSITION:*

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POSITION:*

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POSITION:*

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POSITION:*

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POSITION:*

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POSITION:*

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POSITION:*

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POSITION:*

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POSITION:*

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CUSTOMERS/CLIENTS:

LIST 10 CUSTOMERS/CLIENTS THAT ARE DIFFERENT FROM THE PREVIOUS PROSPECTIVE LEADS LIST (Company & Contact):

1. NAME:*

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2. NAME:*

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3. NAME:*

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4. NAME:*

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5. NAME:*

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6. NAME:*

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7. NAME:*

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8. NAME:*

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9. NAME:*

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10. NAME:*

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COMPANY:*

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COMPANY:*

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COMPANY:*

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COMPANY:*

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COMPANY:*

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POSITION:*

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POSITION:*

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POSITION:*

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POSITION:*

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POSITION:*

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POSITION:*

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POSITION:*

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POSITION:*

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POSITION:*

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POSITION:*

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BANKING & FINANCE CERTIFICATION:

BANK NAME, ADDRESS, TELEPHONE & CONTACT NAME:*

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CREDIT REFERENCE: LIST TWO, INCLUDING NAME, COMPANY, ADDRESS, AND TELEPHONE:

CREDIT REFERENCE #1*

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CREDIT REFERENCE #2*

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PAST FIVE YEAR’S GROSS REVENUES:

YR 1/CURRENT YEAR $:*

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YR 5 $:*

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YR 2 $:*

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YR 3 $:*

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YR 4 $:*

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CERTIFICATION

This application must be certified by an outside accounting firm or other approved independent third party. Only external certified public accountants (CPA), charted accountants (CA) or lawyers. Attorneys are approved as independent third parties. Please note that persons on the EANYC’s member staff, regardless of title are not authorized to sign this form.

The information requested in this application will be confidential and not shared with the general membership. It will be used solely as an indicator of your networking ability. All applications must be accompanied by revenue verification by your CPA. Please notify this representative that the EANYC will be forwarding your application for verification.

INDEPENDENT THIRD-PARTY VERIFICATION:

Please enter the contact information for third-party verification.

Name*

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Company*

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Email*

Please enter a valid email address

Direct Phone Number

Please enter a valid phone number

I understand the information contained in this application will be made available to the members of the Executives’ Association Membership Committee and its Board of Directors. In addition, I understand that I will be interviewed and asked questions concerning my suitability for membership in my firm and myself.

By signing this application, I authorize the Executives’ Association to obtain a business or consumer credit report and background check, and agree to hold the Executives’ Association of New York City and its members harmless regarding information they receive and/or actions they may take with respect to acceptance or rejection of this application.

Two obligations are for the member's Designated Representative to attend at least 50% of the Association's regularly scheduled luncheon meetings each calendar year and the prompt submissions of quarterly business reports, as defined by the Association's Bylaws, policies and procedures.

Sign here*

Sign Above

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Print Your Full Name*

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Dated*

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