Initial Application |
Reinstatement |
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| Personal Information |
*required |
| First Name * |
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| Middle Initial |
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| Last Name * |
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| Spouse First Name |
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| Spouse Middle Initial |
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| Spouse Last Name |
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| # of children |
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| Phone * |
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| Fax |
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| Email Address * |
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| Confirm Email Address |
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| Place of Worship |
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| Date of Birth |
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| Interests/Hobbies |
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| Mailing Information |
| Send 100BMCO mail to: |
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| Mailing Street Address |
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| City |
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| State |
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| Zip |
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| Work Information |
| Company Name |
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| Type of Business |
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| Title |
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| Responsibility |
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Education History
- begin with current or last school attended
- include type of degree(s), school name(s), major(s), and date(s) attended
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| Skills/Talents that can benefit 100BMCO |
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Community / Professional Involvement * - Board and Membership Information. If None, type "N/A".
- include the organization(s) name, your title(s), year elected/joined, and the date when your board term(s) end
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Membership Requirements:
- Applicant must be sponsored/recommended by a member in “good standing” and attend at least one membership meeting before their request for membership is voted on by the Executive Committee.
- The sponsoring member (or designee) is responsible for mentoring the new member for at least the first quarter of new member’s inaugural year.
- Guidelines to maintain membership in "good standing" status:
General Membership
-- Annual Membership dues of $250 paid up
-- Member must be involved in a minimum of 10 hours per quarter with activities pertaining to the 100 BMCO, Inc. All 100 activities, including general body and committee meetings, are included in the count.
Sustaining Membership
-- Annual membership dues of $500 paid up
-- Not required to server on any committee nor has any activity requirement
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Name of 'The 100' member in good standing that is sponsoring you:
(if none, then indicate "Need to obtain") |
| Name: * |
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| Phone: * |
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| List two (2) additional names for character references *: |
| Name: |
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| Phone: |
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| Name: |
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| Phone: |
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| Membership Information / Dues |
| Committee of Interest - Please check the committees that you're interested in joining |
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Mentoring |
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Communication |
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Economic Development |
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Health & Wellness |
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Membership |
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Finance |
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Education |
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Undecided |
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| Membership Dues * - choose one: |
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General Membership ($450) |
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Sustaining Membership ($1,000) |
Affirmation of Commitment * |
(check if you agree)
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I affirm that the statements on this application are correct and agree to abide by the by-laws, oath and mission of the 100 Black Men of Central Ohio, Inc. |
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