MEMBERSHIP REGISTRATION

First Name

Last Name

City

State

Email *

Phone *

I Consent to Receive SMS Notifications, Alerts & Occasional Marketing Communication from company.

Social Media Handles, Facebook

Social Media Handles, Instagram

Social Media Handles, LinkedIn

Membership Type (Please select the type of membership you are applying for)

Community Member (Free)

Business Member (Paid)

SPEAKING EXPERIENCE - Speaking opportunities are a key part of this program. Please complete the section below to share your qualifications:

What topics are you passionate about speaking on?

Please describe your speaking experience:

Beginner (New to public speaking, social media, podcasts)

Intermediate (Some experience with panels, workshops, or small events)

Advanced (Frequent speaker at large events or conferences)

List 1-3 previous speaking engagements or experiences (if applicable):

1. Event/Organization:

2. Event/Organization:

3. Event/Organization:

VIDEO SUBMISSION - As part of the application, please provide a short video (maximum 2 minutes) introducing yourself and sharing why you’re a good fit for this program.

Upload File: (Attach video file here)

OR, Share a Link: (Provide a hyperlink to your video, such as a YouTube or Dropbox link)

FOR COMMUNITY MEMBERS

Tell Us About Yourself

Briefly describe your role or profession (e.g., teacher, mentor, artist, health advocate):

What motivates you to join the Juneteenth NY community?

Contributions to the Community

How do you see yourself contributing to Juneteenth NY’s mission?

What unique skills, talents, or knowledge can you bring to the community?

Areas of Interest

Please select your primary areas of interest:

If Other (please specify here):

FOR BUSINESS MEMBERS

Tell Us About Your Business

Business Name:

Website (if applicable):

Industry/Type of Business:

Briefly describe your business and its mission:

Contributions to the Community

How does your business align with Juneteenth NY’s mission of community empowerment?

Are you interested in being featured in our newsletter’s Business Spotlight or Instagram Live interviews?

YES

NO

FOR BUSINESS MEMBERS

Areas of Support

What areas of support are you most interested in?

If Other (please specify here):

Availability

Please indicate your general availability if an interview is required (e.g., mornings, evenings, weekends):

Important: If approved, all members must attend a MANDATORY virtual orientation. Details will be provided upon acceptance.

ADDITIONAL QUESTIONS

Why do you feel you are a good fit for the Juneteenth NY Membership Program?

What is one unique aspect of your background or work that you would like to share with us?

AGREEMENT AND CONSENT

Thank you for applying!

We will review your application & follow up within 5-7 business days.

For questions or assistance, please contact us at [email protected].

This version clarifies that Instagram Live interviews are guaranteed for Business Members, with priority event speaking opportunities, and explains the newsletter prominence for Business Members. Let me know if there’s anything else to adjust!

MEMBERSHIP REGISTRATION

© 2024 by JuneteenthNYC

© 2024 by JuneteenthNYC