Ambassador Program Interest Form

If you have any questions please email Director of Membership & Retention, Jay Wilson at jayw@bmtcoc.org.

Company Name *

Title

First Name *

Last Name *

Suffix

Email *

Work Number *

Fax Number *

Cell Number *

Address Line 1 *

Address Line 2

City *

Zip/Postal Code *

How much time (hours) can you devote to the Ambassador program monthly? *

Are you interested in being a leader? *

Yes No

Why? Why not? *

What assets do you feel you bring to the committee? *

Why do you want to be an Ambassador representative? *

How long have you been with your current company? *

Other Community Involvement (please include any GBCOC divisions, committee, program, etc): *

How did you find out about the Ambassador Program? Where you referred by a current Ambassador? *

Date and Time *

Format: M/d/yyyy

Company Letter *

Please upload a letter form your company president or management stating they support your application to the Greater Beaumont Chamber of Commerce Ambassador Program.

Ambassador Program Interest Form

Our purpose is to grow the economy, help businesses succeed, and have a positive impact.