Emerald Expression of Interest Form (Ireland)

1 Start 2 20% 3 40% 4 60% 5 80% 6 Preview 7 100%

EMERALD LEADERSHIP PROGRAM APPLICATION FORM

*IMPORTANT: Please note that only financial members will be considered for acceptance into Emerald Leadership program, as a financial membership is a prerequisite for program participation. To activate a financial membership at the appropriate level please click here for more information.

When completing this form please take your time and think clearly about your reasons for applying for a place in Emerald Leadership program. You should understand your goals and be clear about what successful participation looks like for you. Selectors tend to favour those applicants who have a clear sense of the value that their participation can bring to their peers in the group and can articulate them well.

Member Details

First Name *

Last Name *

Email *

Phone Number *

Job Title *

Gender *

Birth Date *

Day

Month

Year

LinkedIn *

Please enter your Linkedin address with http://. e.g. https://www.linkedin.com/yourusername

Twitter

Post Code

Membership Information

Are you a current financial member of the Chamber? *

How many years have you been a financial member? *

How many Chamber events have you attended in the past 12 months? *