Apex Networking Application

Personal Information

  • Name (Required)
    • First
    • Last
  • Email (Required)
  • Business Phone (Required)
  • Mobile Phone (Required)
  • Business Name (Required)
  • Industry/Field (Required)
  • Address (Required)
    • Street Address
    • Address Line 2
    • City
    • State / Province / Region
    • ZIP / Postal Code
    • Country
      • Afghanistan
      • Albania
      • Algeria
      • American Samoa
      • Andorra
      • Angola
      • Anguilla
      • Antarctica
      • Antigua and Barbuda
      • Argentina
      • Armenia
      • Aruba
      • Australia
      • Austria
      • Azerbaijan
      • Bahamas
      • Bahrain
      • Bangladesh
      • Barbados
      • Belarus
      • Belgium
      • Belize
      • Benin
      • Bermuda
      • Bhutan
      • Bolivia
      • Bonaire, Sint Eustatius and Saba
      • Bosnia and Herzegovina
      • Botswana
      • Bouvet Island
      • Brazil
      • British Indian Ocean Territory
      • Brunei Darussalam
      • Bulgaria
      • Burkina Faso
      • Burundi
      • Cabo Verde
      • Cambodia
      • Cameroon
      • Canada
      • Cayman Islands
      • Central African Republic
      • Chad
      • Chile
      • China
      • Christmas Island
      • Cocos Islands
      • Colombia
      • Comoros
      • Congo
      • Congo, Democratic Republic of the
      • Cook Islands
      • Costa Rica
      • Croatia
      • Cuba
      • Curaçao
      • Cyprus
      • Czechia
      • Côte d'Ivoire
      • Denmark
      • Djibouti
      • Dominica
      • Dominican Republic
      • Ecuador
      • Egypt
      • El Salvador
      • Equatorial Guinea
      • Eritrea
      • Estonia
      • Eswatini
      • Ethiopia
      • Falkland Islands
      • Faroe Islands
      • Fiji
      • Finland
      • France
      • French Guiana
      • French Polynesia
      • French Southern Territories
      • Gabon
      • Gambia
      • Georgia
      • Germany
      • Ghana
      • Gibraltar
      • Greece
      • Greenland
      • Grenada
      • Guadeloupe
      • Guam
      • Guatemala
      • Guernsey
      • Guinea
      • Guinea-Bissau
      • Guyana
      • Haiti
      • Heard Island and McDonald Islands
      • Holy See
      • Honduras
      • Hong Kong
      • Hungary
      • Iceland
      • India
      • Indonesia
      • Iran
      • Iraq
      • Ireland
      • Isle of Man
      • Israel
      • Italy
      • Jamaica
      • Japan
      • Jersey
      • Jordan
      • Kazakhstan
      • Kenya
      • Kiribati
      • Korea, Democratic People's Republic of
      • Korea, Republic of
      • Kuwait
      • Kyrgyzstan
      • Lao People's Democratic Republic
      • Latvia
      • Lebanon
      • Lesotho
      • Liberia
      • Libya
      • Liechtenstein
      • Lithuania
      • Luxembourg
      • Macao
      • Madagascar
      • Malawi
      • Malaysia
      • Maldives
      • Mali
      • Malta
      • Marshall Islands
      • Martinique
      • Mauritania
      • Mauritius
      • Mayotte
      • Mexico
      • Micronesia
      • Moldova
      • Monaco
      • Mongolia
      • Montenegro
      • Montserrat
      • Morocco
      • Mozambique
      • Myanmar
      • Namibia
      • Nauru
      • Nepal
      • Netherlands
      • New Caledonia
      • New Zealand
      • Nicaragua
      • Niger
      • Nigeria
      • Niue
      • Norfolk Island
      • North Macedonia
      • Northern Mariana Islands
      • Norway
      • Oman
      • Pakistan
      • Palau
      • Palestine, State of
      • Panama
      • Papua New Guinea
      • Paraguay
      • Peru
      • Philippines
      • Pitcairn
      • Poland
      • Portugal
      • Puerto Rico
      • Qatar
      • Romania
      • Russian Federation
      • Rwanda
      • Réunion
      • Saint Barthélemy
      • Saint Helena, Ascension and Tristan da Cunha
      • Saint Kitts and Nevis
      • Saint Lucia
      • Saint Martin
      • Saint Pierre and Miquelon
      • Saint Vincent and the Grenadines
      • Samoa
      • San Marino
      • Sao Tome and Principe
      • Saudi Arabia
      • Senegal
      • Serbia
      • Seychelles
      • Sierra Leone
      • Singapore
      • Sint Maarten
      • Slovakia
      • Slovenia
      • Solomon Islands
      • Somalia
      • South Africa
      • South Georgia and the South Sandwich Islands
      • South Sudan
      • Spain
      • Sri Lanka
      • Sudan
      • Suriname
      • Svalbard and Jan Mayen
      • Sweden
      • Switzerland
      • Syria Arab Republic
      • Taiwan
      • Tajikistan
      • Tanzania, the United Republic of
      • Thailand
      • Timor-Leste
      • Togo
      • Tokelau
      • Tonga
      • Trinidad and Tobago
      • Tunisia
      • Turkmenistan
      • Turks and Caicos Islands
      • Tuvalu
      • Türkiye
      • US Minor Outlying Islands
      • Uganda
      • Ukraine
      • United Arab Emirates
      • United Kingdom
      • United States
      • Uruguay
      • Uzbekistan
      • Vanuatu
      • Venezuela
      • Viet Nam
      • Virgin Islands, British
      • Virgin Islands, U.S.
      • Wallis and Futuna
      • Western Sahara
      • Yemen
      • Zambia
      • Zimbabwe
      • Åland Islands
  • Website
  • Apex Sponsor's Name
  • How did you find us?

Background

  • Years of Experience in Field (Required)
  • Educational Background in Industry, Including Certificates and Licenses (Required)
  • Is this your primary occupation? (Required)
    • Yes
    • No

Expectations

  • Are you willing and able to meet the attendance policy for Apex Networking, and find substitutes when necessary? (Required)
    • Yes
    • No
  • Are you willing and able to find referrals and bring visitors in accordance with the Apex Networking requirements? (Required)
    • Yes
    • No
  • Do you belong to another networking group that requires exclusive membership rules? (Required)
    • Yes
    • No
  • Are you willing to abide by the established Code of Ethics? (Required)
    • Yes
    • No
  • Do you agree to adhere to the rules and regulations of Apex Networking? (Required)
    • Yes
    • No
  • Have you ever been convicted of a felony? (Required)
    • Yes
    • No

References

  • Please provide two professional references. Please do not use employees or family members.

    • Name Reference #1 (Required)
      • First
      • Last
    • Company Reference #1 (Required)
    • Relationship to Reference #1 (Required)
    • Phone Reference #1 (Required)
    • Name Reference #2 (Required)
      • First
      • Last
    • Company Reference #2 (Required)
    • Relationship to Reference #2 (Required)
    • Phone Reference #2 (Required)

  • I agree that this information is accurate and valid, and that Apex Networking membership committee may contact my references for the purposes of verifying eligibility. (Required)

    • I Agree