New MyNetwork Member Application

New MyNetwork

Member Application

We are excited about your interest in MyNetwork membership.

Our next season will launch in October. Please submit your application below and we will circle back to you as we begin to seat the upcoming season this coming fall.

We take very seriously the importance of group synergy and will do our best to seat you at the table that is right for you if there is an opening.

As soon as your application has been reviewed, you will be contacted by a member of the MyNetwork team. In the meantime, if questions arise, please contact MyNetwork@BIGiOK.com

Thank you for your application!

Sara, Julie and Emma

Your friends at MyNetwork

First Name*

Last Name*

Business Email*

Personal Email

This is simply for backup email communications. It will not be used unless necessary by network coordinators.

Organization*

Title - Position*

How many years of experience do you have?*

Cell Phone*

Phone

Office Phone*

Phone

Mailing Address*

City*

State*

Zip*

Birthdate: MM/DD*

Please list your Kolbe MO here (Ex: 8732).

If you haven't taken this assessment yet, and are interested please also make that note below and we'll make sure to notify you when that workshop is available.

Please list your DiSC style below. (Ex: DC)

If you haven't taken this assessment yet, and are interested please also make that note below and we'll make sure to notify you when that workshop is available.

What's the biggest challenge you face as a female leader?*

How did you hear about MyNetwork?*

What type of peer group would you like to be seated with?*

Select

Why are you interested in joining a MyNetwork mastermind group?*

Additional Private Coaching Bundles

Each MyNetwork membership includes 2 private coaching sessions with your network facilitator but for some that's not enough.

This pricing includes a $100 discount on standard Coaching Bundles provided outside of MyNetwork groups.

Choose either option below and we'll include it in your membership fee billing.

Select or enter value

Membership Payment Information:

Invoice - Your invoice will be sent electronically from The Independent Insurance Agents of Oklahoma and will include a MyNetwork membership notation.

You may pay by ACH or Credit Card through the Epay policy option in the invoice email body. Payment of your invoice is due within 30 days after the invoice date.

3 Auto-Pay Installments: If you choose this option you will be contacted by our accounting department to set this up on either ACH bank draft or credit card.

Please select your payment preference below.

Payment Method*

Invoice

3 Auto-Pay Installments

Please upload your headshot:

Your photo will be used in the PowerPoint deck for each of your network sessions.

Don't worry if you don't have a professional headshot though. Even a photo of you with someone else will be fine if we can edit it and have a good representation of you for your co-MyNetworkers.

Drag and drop files here or

Send me a copy of my responses

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