YPO Dallas Membership Application

PROFESSIONAL & COMPANY INFORMATION

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* 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.

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* 2. Referred By:

Name:

Company:

Email:

Tel:

YPO Chapter:

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* 3. Age (You must be under 45 without a waiver):

DOB (MM/DD/YY):

Current Age (Yrs):

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* 4. Company Information:

Company Name:

Title:

Address:

Tel:

Web Site:

LinkedIn URL:

Description:

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* 5. Executive Type:

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* 6. Industry:

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* 7. Company Type (Public or Private):

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* 8. Your Ownership %:

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* 9. Is Business a Division of a Larger Company:

Yes (Please Explain)

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* 10. Is a YPO Member affiliated with or related to your qualifying company?

Yes (Please Explain)

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* 11. The Number of Full-Time Employees, Excluding You:

Employees:

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* 12. If Your Company Has Less Than 50 Employees, the Total Annual Compensation of All Employees, Excluding You:

Employee Comp:

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* 13. For Operating Businesses, Last 12 Month Sales:

Sales:

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* 14. For Financial Institutions & Asset Managers, Current AUM:

Company AUM:

AUM for which you are responsible (if different):

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* 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:

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* 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):

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* 17. Executive Assistant's Information:

Name:

Email:

Tel:

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* 18. Personal Reference:

Name:

Relationship to You:

Email:

Tel:

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* 19. Trade or Industry Reference:*

Name:

Title:

Company:

Email:

Tel:

*References may be contacted by the Membership Committee.

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* 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

Member's Dues: Annual dues for YPO International and YPO Dallas are $4,150 and $9,000 respectively 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.