Coffee Connections Application Form

Mission Statement
The purpose of the Tempe Chamber Coffee Connections & Leads @ Lunch is to develop groups that will advocate and promote the businesses of members within each group by passing qualified business leads to other members within each group.

Please review the Policies & Procedures prior to applying.

I'm applying for:*

Coffee Connections (2nd & 4th Wednesday of the month from 7:30-8:30am)Leads @ Lunch (2nd & 4th Tuesday of the month from 11:30am-12:30pm)Whichever group has my industry available

Contact Information

Name:*

First NameLast Name

Office Phone Number:*

Area CodePhone Number

Mobile Phone Number:*

Area CodePhone Number

E-mail Address:*

LinkedIn Profile URL:

Business Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Industry Information

To help us identify if your industry is currently represented in Coffee Connections or Leads @ Lunch, please provide us with information about what industry you serve. CLICK HERE To see the full industry list and openings.

Please indicate the industry that your business services:*

Please specify your specialization in your industry:*

Job Title/Experience*

Please summarize special skills and qualifications you have acquired from employment, previous networking events or through other activities, including Chamber positions or committees.

Special Skills or Qualifications*

Agreement & Signature

By submitting this application I affirm that the facts set forth in it are true and complete. I understand that if I am accepted as a member, I must be an active member of the Tempe Chamber and be current with the $75.00 Coffee Connections or Leads @ Lunch annual dues. Additionally, I understand and will abide by the policies and procedures set forth by the Tempe Chamber.

Name*

First NameLast Name

Signature*

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Today's Date*

Date

COFFEE CONNECTIONS APPLICATION