Name: _________________________________________ Date:
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Address:
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City /State/ Zip code:
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Day Tel.: (____) ____-_________ PM Tel.: (____)
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NAIC Membership No.______________ Invited by: _________________________
Are you a member of an NAIC investment club(s)?________________
Club Name(s): __________________________________________________________
Club Offices held:_______________________________________________________
What other organizations are you active in? Leadership positions held?______________
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Presently employed?___ Company name where you are employed?__________________
Describe type of work you do:_______________________________________________
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Do you use a computer? ___________ Level of competency: ______________________
Do you use/have access to e-mail at home? ____Address:_____________@_____________
Investment software programs you use/know ? __________________________________
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Do you do your own investment research? _____________________________________
How long have you been investing in common stocks? __________________
What NAIC stock study tools are you proficient with, check all that apply below:
SSG ______ SCG _____ PMG _____ PERT ____ Challenge Tree _______
NAIC Council educational course(s) you have completed: _________________________
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Have you ever attended an Investors Fair sponsored by a local NAIC Council? _________
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Please include any additional information about yourself that you feel would be of interest to the "Tri-State" partners in evaluating your application to become a partner. _________________________________________________________________
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Skills:
Advertising ___ Organization _____ Leadership ____
Audio Visual ____ Meeting Planning _____ Admin. Asst. ______
Public Relations ____ Sales & Marketing _____ Finance _____
Writing/Editing ____ Public Speaking _____ Law ____
Graphics/Art ____ Training/Teaching _____ Management ____
Signature: _________________________________________ Date: ___________