About the Program

Registration Form for E | M | S

Note: You will be notified of your acceptance to EMS via email within 2 weeks of your application submission. If approved, please make payment of $200, which will cover yearly membership dues, through EMS website or by sending a check to:

Entrepreneur Mentor Society
9748 Variel Ave Chatsworth, CA 91311

Personal Information

First Name *

Last Name *

Street Address *

Apartment/Unit #

City *

State *

ZIP Code *

Home Phone

Alternative Phone

E-mail *

Education Information

Current University *

Dates of Attendance *

Major(s)/Minor(s) *

Expected Date of Graduation

GPA (Cumulative) *

GPA (Major)

Work Experience

Company

Position

Supervisor

Employment Date

Past Work Experience

Company

Position

Supervisor

Employment Date

Personal Statement

Please tell us about an entrepreneurial/organizational initiative/service organization that you participated in. what was your greatest contribution to the organization? *

Why do you want to be in the program? *

Does your family own a business? *