Please fill out the form below. If you have already applied but still need to pay, pay the fee here).
Full Name *
Address 1 *
Address 2
City *
State *
Zipcode *
Home Phone
Mobile Phone
Fax
E-mail *
Have you participated in any other programs at the Greater Greenville Chamber of Commerce? Please list.
What days of the week best fits your schedule? Please select at least two. * Monday Tuesday Wednesday Thursday Friday
What time of day best fits your schedule? Please select at least two. * Morning Noon Afternoon Evening Anytime
Which Community and Business Leaders would you like to see Participate in the program either as Mentors or Guest Speakers?
Which is more of a concern for you, time of day, or who your mentor might be? Day of Week Time of Day Mentor
OPTIONAL: In order to maintain diverse groups that are representative of the diversity in Greenville County, we encourage you to complete the following information:
What is your age? 20 to 25 26 to 30 31 to 35 36 to 40
What is your gender? Male Female
What is your race? White African American Hispanic/Latino Other
Business or Organization Name *
Position/Title *
Business Address 1 *
Business Address 2
Business City *
Business Phone
Business Fax
Business Mobile Phone
Business E-mail
Are you self-employed? Yes No
Please explain what type of organization you work for and what your role is in this organization.
Applicant: I understand the purpose of PULSE Pace Setters. I have read and agree to the following rules off PULSE Pace Setters outlined below:
1. Commitment: Because everyone is busy and their time is important, attendance to all meetings is mandatory! Each member is permited one absence. Any more than that will be judged on a case-by-case basis and may result in a request to leave the group.
2. Confidentiality: Your fellow PaceSetters must have total certainty that everything discussed in the group will remain confidential. Breaches of confidence will almost always result in a request to leave the group.
3. Conduct: PULSE PaceSetters are required to conduct themselves in a professional manner during each meeting. Furthermore it is expected that each member will:
By checking this box, I agree to be bound by this commitment. *
Signature (Please type) *
Applicants Employer: This applicant has the approval and full support of this organization including the time required to successfully complete the program. I agree to provide adequate release time from regular duties to attend the required sessions and activities.
(For applicants who answer directly to a board of directors, such as an executive director of a non-profit organization, please list below the board president or chair.)
Employer Supervisor name
Join PULSE Now »