MEMBERSHIP APPLICATION

This is the application for consideration of induction into the 100 Black Men of Metropolitan St. Louis. Completion of this application is required along with the following information:

1) Identification of a Sponsor who is a current member of the 100 Black Men.

2) 2 (two) letters of recommendation

3) A copy of your CV or résumé

4) Payment of your application fee ($200)

Applicant Information

First name

Last name

Email

Phone

Multi-line address

Country/Region

Address

City

Zip / Postal code

Date of Birth

Month

Day

Year

Sponsor's Name

Marital Status

Single

Married

Educational Background

Currently Enrolled in School?

Yes

No

Undergraduate College/University

Undergraduate Degree

Graduate College/University

Graduate Degree

Special Certifications/Licenses

Employment Information

Employer Name

Position Title

Work Phone

Professional Awards or Recognitions

Community / Civic Engagement

Board Memberships

List any companies or organizations of which you sit on a Board of Directors, as well as your role with that organization.

Organization Memberships

List any Professional, Social, Fraternal, or other organizations of which you are a member.

Membership Interest

Interest in Organization

Provide a brief summary of why you would like to be a member of the 100 Black Men of Metropolitan St. Louis.

Special Skills and Qualifications

List any special skills and qualifications you have acquired from employment, previous work, or through other activities including hobbies or sports.

Emergency Contact

Emergency Contact Name

Emergency Contact Phone

Application Completion

Attach recommendation letters and a copy of your CV or Résumé.

Acknowledgement of 2 letters of recommendation and a CV or résumé must be sent to complete application.

Upload Recommendation Letters

Upload CV or Résumé

Application Consent

I give permission for 100 Black Men of Metropolitan St. Louis to take photographs of me, aware that they may use such photographs of me with or without my name and for any lawful purpose, including for such purposes as publicity, illustration, advertising, and web content, and to use and publish the same in print and/or electronically. I also agree to submit to a background check.

Acceptance Disclaimer

This application is for the consideration for membership into the 100 Black Men of Metropolitan St. Louis. Completion of this application and payment of the application fee does NOT certify membership. I understand that additional considerations are required, and approval and induction into the organization is of the sole discretion of the organization itself.

Application Fee

$200

There is a $200 non-refundable application fee, to cover the application processing and background check. Click on the link below to be taken to the payment site for payment prior to submission completion.

It is the policy of this organization to provide equal opportunities without regard to race, color, religion, sexual orientation, national origin, age, veteran or disability status. Thank you for completing this application form and for your interest.

100 Black Men of Metropolitan St. Louis, 4631 Delmar Blvd. St. Louis, MO 63108 (314) 367-7778 office, (314) 367-7771 fax, www.100blackmenstl.com.