Business Partner Application Form - Keystone Chapter of APPA

Business Categories

Name of Company or Organization*

Business Address*

City*

State*

Postal/Zip code*

Business Phone Number*

Business Fax Number*

Core Business Functions*

Name of Organization’s Designated Applicant*

Title of Organization’s Designated Applicant*

Applicant’s Email Address*

Primary Reason for submission of application*

Other Organizational Affiliations*

How can your Organization or Business contribute to the growth and development of KAPPA Educational and Organizational Members*

List the Names, titles and e‐mails of potential company personnel that may attend meetings from your Business:

1. Additonal personnel

Name

Title

Email

2. Additonal personnel

Name

Title

Email

3. Additonal personnel

Name

Title

Email

Educational sponsorship form:

Name / Title of EDU Sponsor*

E‐mail*

Sponsor’s Institution*

Years of experience with Organization Applying for Membership*

Statement in Support of Application*