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Business Category

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Application For Membership

The objectives of the Executives’ Association of New York City are to institute and maintain a continuous interchange of business information among its members in a setting that promotes friendship, encourages cooperation, fosters improved efficiency and service, expands business opportunities and aids each member to grow within its own local, national and foreign markets. Membership is open to companies, firms, and organizations. For ease in completing this application, all entities are referred to as “companies.”

Current Membership Dues and General Application Guidelines

Member may not represent an existing Exclusive Member Classification and must have a minimum annual gross revenue of $5M (certain exceptions may be allowed as determined by the Membership Committee).
The Designated Representative must be an Owner, Officer or other key decision maker of the Member as determined by the Membership Committee.
The Designated Representative is required to attend at least 50% of networking events on an annual basis.
The Designated Representative may not belong to other formalized networking groups located in the Greater NYC area with a similar mission as EANYC. This excludes Vistage, EO, YPO, and Industry Trade Groups.

Membership Fee and Dues:

$250 Non-refundable application fee
$750 Initiation fee – Due upon acceptance as a Member Candidate
$1500 Quarterly Dues – Due upon acceptance as a Member Candidate

Please note that EANYC bylaws preclude a designated representative from belonging to another formalized networking group. However, Vistage, EO, YPO, and Industry Trade Groups are allowable.

Companies must have a minimum gross revenue of $5M or above in the previously reported annual financial statement. Exceptions to this requirement may be approved at the sole discretion of the Membership Committee.

Applicants are required to list the line item from their company's tax return for the past five years filed. Given the type of tax classification of the applying company, the chart below lists the appropriate line numbers where this information can be found. Please obtain this information before proceeding with your application to avoid having to restart the process.

	Form	Page #	Line
S-Corp	1120-S	1	1C
LLC	1040, Schedule C	1, Part I	3
Partnership	1065	1	1C
C Corp	1120	1	1C

APPLICATION FEE*

APPLICATION FEE (NON-REFUNDABLE) - $250.00 USD

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Choose Payment

Pay via Credit Card

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APPLICATION TOTAL:*

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ABOUT YOUR COMPANY

NAME OF COMPANY AND ANY D/B/A:*

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APPLICATION DATE:*

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BUSINESS DESCRIPTION:
What is the company’s primary business?*

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BREAKDOWN OF BUSINESS:
What other business activities does the company engage in? (Please provide the percentage of revenues from each business activity the company engages in)*

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Company Address*

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City*

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Company Phone Number*

Please enter a valid phone number

State*

Please choose your company state

Website*

Please enter a website URL starting with "http://" or "https://"

Zip Code*

You must enter a valid five digit USA zipcode.

MEMBER REPRESENTATIVE INFORMATION

First Name*

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Last Name*

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DATE OF BIRTH

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Home Address

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City

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Direct Email*

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State

Please choose your home state

Direct Phone Number*

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Zip Code

Please enter a valid US zip code

DUTIES AND RESPONSIBILITIES*

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PERSONAL AUTHORITY IN COMPANY*

IN GOVERNANCE

IN STRATEGY PLANNING

IN HIRING AND DISCHARGING

IN OPERATIONS

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EDUCATION*

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HOW MANY EMPLOYEES REPORT TO YOU?*

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START DATE AT COMPANY*

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HOBBIES, INTERESTES AND PHILANTHROPIC INVOLVEMENT

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OTHER PROFESSIONAL EXPERIENCE

PREVIOUS EMPLOYMENT (Name, address and number of years with company)*

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PROFESSIONAL CERTIFICATIONS & EDUCATION*

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LIST ANY OTHER MEMBERSHIPS HELD OR NETWORKING ASSOCIATIONS. (INCLUDE ANY OFFICE POSITIONS HELD)

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Sponsor Information

IS THERE A SECOND SPONSOR:

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PROSPECTIVE LEADS & CLIENTS

LIST TEN INDIVIDUALS YOU KNOW PERSONALLY AND CAN RECOMMEND AS PROSPECTIVE LEADS TO OTHER MEMBERS: (Company & Contact)

1. NAME:*

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2. NAME:*

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3. NAME:*

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4. NAME:*

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5. NAME:*

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6. NAME:*

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7. NAME:*

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8. NAME:*

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9. NAME:*

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10. NAME:*

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COMPANY:*

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COMPANY:*

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POSITION:*

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POSITION:*

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POSITION:*

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POSITION:*

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POSITION:*

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POSITION:*

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POSITION:*

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POSITION:*

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POSITION:*

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POSITION:*

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CUSTOMERS/CLIENTS:

LIST 10 CUSTOMERS/CLIENTS THAT ARE DIFFERENT FROM THE PREVIOUS PROSPECTIVE LEADS LIST (Company & Contact):

1. NAME:*

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2. NAME:*

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3. NAME:*

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4. NAME:*

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5. NAME:*

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6. NAME:*

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7. NAME:*

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8. NAME:*

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9. NAME:*

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10. NAME:*

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COMPANY:*

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POSITION:*

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POSITION:*

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POSITION:*

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BANKING & FINANCE CERTIFICATION:

BANK NAME, ADDRESS, TELEPHONE & CONTACT NAME:*

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CREDIT REFERENCE: LIST TWO, INCLUDING NAME, COMPANY, ADDRESS, AND TELEPHONE:

CREDIT REFERENCE #1*

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CREDIT REFERENCE #2*

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PAST FIVE YEAR’S GROSS REVENUES:

Applicants should list the line item from their company's tax return for the past five years filed. Given the type of tax classification of the applying company, the chart below lists the appropriate line numbers where this information can be found.

	Form	Page #	Line
S-Corp	1120-S	1	1C
LLC	1040, Schedule C	1, Part I	3
Partnership	1065	1	1C
C Corp	1120	1	1C

YR 1/CURRENT YEAR $:*

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YR 5 $:*

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YR 2 $:*

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YR 3 $:*

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YR 4 $:*

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CERTIFICATION

This application must be certified by an outside accounting firm or other approved independent third party. Only external certified public accountants (CPA), charted accountants (CA) or lawyers. Attorneys are approved as independent third parties. Please note that persons on the EANYC’s member staff, regardless of title are not authorized to sign this form.

The information requested in this application will be confidential and not shared with the general membership. It will be used solely as an indicator of your networking ability. All applications must be accompanied by revenue verification by your CPA. Please notify this representative that the EANYC will be forwarding your application for verification.

INDEPENDENT THIRD-PARTY VERIFICATION:

Please enter the contact information for third-party verification.

Name*

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Company*

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Email*

Please enter a valid email address

Direct Phone Number

Please enter a valid phone number

I understand the information contained in this application will be made available to the members of the Executives’ Association Membership Committee and its Board of Directors. In addition, I understand that I will be interviewed and asked questions concerning my suitability for membership in my firm and myself.

By signing this application, I authorize the Executives’ Association to obtain a business or consumer credit report and background check, and agree to hold the Executives’ Association of New York City and its members harmless regarding information they receive and/or actions they may take with respect to acceptance or rejection of this application.

Two obligations are for the member's Designated Representative to attend at least 50% of the Association's regularly scheduled luncheon meetings each calendar year and the prompt submissions of quarterly business reports, as defined by the Association's Bylaws, policies and procedures.

Sign here*

Sign Above

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Print Your Full Name*

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Dated*

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