Membership Application: PFBI Family Business Leadership Network

Attention: Before completing this application, please read about the PFBI Family Business Leadership Network and the commitments associated with membership.

The information provided in this application form will be held confidential and used for contact and evaluation purposes only. We will follow up to schedule a face-to-face or telephone interview if necessary.


Your Name *
Your Name
Please list the names, ages, and relationships of all family members, including spouses, who work in the business with you.
List all positions you have held in the family business, including approximate dates, beginning with your current position and title.
Are you a sharedholder in the family business? *
Date of Birth
Date of Birth
Mailing Address *
Mailing Address
Business Phone *
Business Phone
Cell Phone *
Cell Phone
Agreement *