CBMC Membership Application

Personal Information

First Name *

Please provide your first name.

Last Name *

Please provide your last name.

Name of Spouse *

Please provide your spouse's name.

Birth Date (mm/dd/yyyy) *

Please provide your birth date.

Gender *

Please select your gender.

Church Affiliation

Contact Information

Email *

Please provide a valid email address.

Mobile Phone *

Please provide your mobile phone number.

Home Street Address *

Please provide your home address.

City/Town *

Please provide your city/town.

State *

Please select your state.

Zip Code *

Please provide your zip code.

Country

Preferred Mailing Address *

Please select your preferred mailing address.

Fax

Web Site

Business Information

Business Name *

Please provide your business name.

Business Street Address *

Please provide your business address.

Business City *

Please provide your business city.

Business State *

Please select your business state.

Business Zip Code *

Please provide your business zip code.

Position in Company *

Please provide your position in the company.

Years in Position *

Please provide years in position.

Percent of Ownership (Number Only) *

Please provide percent of ownership.

Year Company Established

Number of Employees

Gross Sales Last Year

Is Business Profitable?

Yes

No

Information to Assist in CBMC Peer Advisory Group Placement

Select Team Type *

Please select a team type.

Select Area *

Please select an area.

Team Name *

Please provide a team name.

Team Leader's Name *

Please provide the team leader's name.

Additional Information

Describe the nature of business. *

Please describe the nature of your business.

What do you consider the biggest issue(s) relating to your business? *

Please describe your business issues.

How did you learn about CBMC Peer Advisory Groups? *

Please tell us how you learned about CBMC Peer Advisory Groups.

Do you know someone else we should contact who also might want to be part of a peer advisory group? *

Please provide referral information.

Membership Application (Continued)

Member Covenant – CBMC Peer Advisory Groups

General Purpose

The purpose of CBMC Peer Advisory Groups is to help a business leader become the leader God designed them to be while building a business of excellence that glorifies God. We help business leaders learn how to integrate Biblical principles into their personal lives and the operation of their business. The peer advisory group is another form of discipleship and growing in Christ-likeness. This process of discipleship may also lead to evangelism, using the business leader's own sphere of influence to inculcate the culture and share their faith in Jesus Christ as Lord and Savior. CBMC Peer Advisory Groups provides an opportunity for business leaders to meet in a comfortable, confidential setting with other leaders of similar business responsibilities to present concerns and problems, and receive Godly counsel. The members will meet faithfully to help each other apply Biblical principles to everyday life and to the operation of their business.

Member Commitment

I support CBMC's Statement of Faith and as a Member I will seek to glorify God in my business and personal life by living according to Biblical principles.

I will maintain a teachable attitude, being transparent and truthful.

I will be involved in the meeting dialogue and will do so when scheduled.
I will be involved in the meeting dialogue and the lives of my fellow members.
I will faithfully attend meetings and be punctual.
I am willing to host the meeting and will do so when scheduled.

I understand that my commitment to the team is for an entire year and renews annually.

I understand that a cancellation of membership should be provided 90 days in advance.

I understand this is a non solicitation environment.

Confidentiality

CBMC Peer Advisory Groups are small groups of non-competing business leaders meeting with a high degree of trust; each member signing this agreement agrees to maintain the utmost level of confidentiality, and will not disclose personal or business related items or issues presented and discussed during the peer advisory group meeting to anyone outside the group (including his spouse).

If any member fails to maintain this level of confidentiality by discussing or disclosing any material or conversation to any parties, this member may be brought before the group and be asked to withdraw from any further proceedings in conjunction with this CBMC Peer Advisory Group.

Proverbs 11:12-14 "He who is devoid of wisdom despises his neighbor, but a man of understanding holds his peace. A talebearer reveals secrets. But he who is of a faithful spirit conceals a matter. Where there is no counsel, the people fall; but in the multitude of counselors there is safety."

Mark to indicate you have read and agree to the CBMC Peer Advisory Group Covenant above. *

You must agree to the covenant before submitting.

Payment Information

Select Donation Frequency *

Monthly ($200/month)

Quarterly ($600/quarter)

Annual ($2,400/year)

Please select a donation frequency.

Payment Method *

Credit Card

Direct Bank Payment

Please select a payment method.

TAF & YP Membership Application