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YPO Dallas Membership Application
PROFESSIONAL & COMPANY INFORMATION
1.
Contact Information & Bio:
Name(First/M/Last):
Preferred Name:
Cell Phone:
Preferred Email:
Home Address:
Home Tel:
LinkedIn URL:
Facebook URL:
@Twitter:
Extended Bio (Required)*:
*Please note, the Bio section above will be sent to YPO Dallas Members to introduce your candidacy.
2.
Referred By:
Name:
Company:
Email:
Tel:
YPO Chapter:
3.
Age (You must be under 45 without a waiver):
DOB (MM/DD/YY):
Current Age (Yrs):
4.
Company Information:
Company Name:
Title:
Address:
Tel:
Web Site:
LinkedIn URL:
Description:
5.
Executive Type:
Hired Gun (You may own part of the business but you were hired to run it.)
Entrepreneur (You founded the company or acquired control with your own capital.)
Family Business (Someone in your family started the business and you now run it.)
Family Office (Your family owns multiple businesses of which you have oversight for one or more.)
Other (please specify)
6.
Industry:
Advertising & Marketing
Asset Management
Automotive
Construction (Residential & Commercial)
Distribution & Logistics
Education
Entertainment & Leisure
Finance & Financial Services (other than asset management)
Food & Beverage
Government Services
Healthcare & Pharmaceuticals
Manufacturing & Industrial
Real Estate Investment & Development
Retail & Consumer Durables
Telecommunications, Technology, Internet & Electronics
Transportation
Utilities, Energy, and Extraction
Other (please specify)
7.
Company Type (Public or Private):
Public
Private
8.
Your Ownership %:
9.
Is Business a Division of a Larger Company:
No
Yes (Please Explain)
10.
Is a YPO Member affiliated with or related to your qualifying company?
No
Yes (Please Explain)
11.
The Number of Full-Time Employees, Excluding You:
Employees:
12.
If Your Company Has Less Than 50 Employees, the Total Annual Compensation of All Employees, Excluding You:
Employee Comp:
13.
For Operating Businesses, Last 12 Month Sales:
Sales:
14.
For Financial Institutions & Asset Managers, Current AUM:
Company AUM:
AUM for which you are responsible (if different):
15.
Enterprise Value, if sales are less than $30M or if AUM is less than $600M. Must be supported by (i) an independent third-party investment or (ii) the sum of the company’s public equity value plus its debt less cash.
Enterprise Value:
16.
Your Previous Two Work Experiences (if within the last 10 years):
1. Company Name:
Position:
Years (From-To):
2. Company Name:
Position:
Years (From-To):
17.
Executive Assistant's Information:
Name:
Email:
Tel:
18.
Personal Reference:
Name:
Relationship to You:
Email:
Tel:
19.
Trade or Industry Reference:*
Name:
Title:
Company:
Email:
Tel:
*
References may be contacted by the Membership Committee.
20.
Certification:
I certify the above information is correct and company's financials can be verified by the company's records and/or its auditor.
Name:
Date:
Membership Requirement Notification
Membership Dues
: Annual dues are $4,650.00 for YPO International and $9,000 for YPO Dallas.
YPO International has a one-time initiation fee of $4,650.00 , and YPO Dallas has a one-time initiation fee of $15,000.
Participation
:
Members must attend at least 6 events per year (there are ~18 qualifying events per year) and join a Forum within 6 months of admission.
Please click "Next" below to continue to the Personal & Spouse/Partner Information section.
