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Section I: Personal & Professional Information
User Name*:
Password*:
Email*:
First Name*:
Last Name*:
Address:
Date of Birth: Year
Tel*:
Fax:
Mobile:
URL:
Position:
Education:
Company Name:
Company Profile:
Sector of Activity*:
Please specify if Others:
How do you hope to benefit from joining YEA:
Section II: YEA Contribution & Benefits
How did you know about YEA?:
I wish to join the following YEA Committees (You may check as many as you want)
Membership Services Committee
Public Relations Committee
Networking Committee/Inactive
Education and Training Committee/Inactive
Public Policy Advocacy Committee
Forum Committee
I wish to contribute/benefit to/from the following YEA services (You may check as many as you want)
Venture Capital Funding Project Screening Committee   I need Mentoring  
Education & Training How to Establish my Own Venture I want to be a Mentor
Membership Benefits Networking With Others Sectors Regional Portal 
Tomorrow's Entrepreneur Program Regional / Global Networking SME Exchange Program

Section III: Membership and Other Activities
 Are you a member in other Professional Organizations and/or NGO's Yes No
 If Yes please indicate which ones in the table below:

Organization

Member Since

Board Member
Yes No Was
Yes No Was
Yes No Was
Yes No Was
Yes No Was
 Please list your hobbies in order of preference:

Section IV: Other Information and Comments
 Kindly recommend one or more potential members' names with any of their contact information:
 
*Note: Membership Fees: Initiation fees=100JD + 75JD (Depending on the month you join)