Membership Application Name * First Name Last Name Title Phone (###) ### #### Email * Years of total business experience: Company Name: Number of Employees Company Address: Address 1 Address 2 City State/Province Zip/Postal Code Country Industry: Brief description of the business: Annual Membership Type: * Check both options if you prefer a Combined Membership in both groups. The Pittsburgh Business Collective (Coed Networking Group) The Women's Collective (Women Only Group) How did you hear about us? What are your goals for joining us (check all that apply): * Referrals Idea Exchange Camaraderie Professional Development Other If you selected other above, please explain What types of people would you like to meet (by industry or role)? * We will review your application and once approved, we will contact you about how to purchase a membership. Thank you for your interest!