Application for Membership 2015 First Name Surname Address Postcode Email Landline LinkedIn Initials Mobile Website Business Experience Summary: (please give a summary of your business background and achievements 250 words maximum) 1 Association of Business Mentors, 73 Temple Sheen Road, London SW147RS Registered Address: The White House, 19 Ash Street, Ash GU12 6LD Registered Company Number 753326 Limited by guarantee. Not for profit. When did you start business mentoring? A minimum of two years is required Mentoring Experience: please give a summary of your experience in mentoring for individuals /companies/ team. Include coaching if you feel appropriate however please differentiate between the two services. Relevant qualifications with accredited body and dates – There is a minimum requirement of one (full day) workshop or course    Current Association Memberships:    2 Association of Business Mentors, 73 Temple Sheen Road, London SW147RS Registered Address: The White House, 19 Ash Street, Ash GU12 6LD Registered Company Number 753326 Limited by guarantee. Not for profit. As part of the membership process we undertake background checks of the details you supply. Do you consent to this: Y/N? Insurance details – PI insurance is a prerequisite for membership Broker: Professional Indemnity cover £ Public Liability cover £ Please highlight your areas of proven expertise: Strategy Funding Marketing & PR Legal Operations Change Management Finance Other IT/Technology Other People & HR Industry of preference International Growth Industry of preference The aim of this association is to provide a regulatory body for business mentors to inspire confidence in the business owners seeking business mentoring. It will also provide regular news, training and seminars. By signing below you confirm that you have read and agree to the code of ethics and necessary procedures of the Association of Business Mentors. Signature ................................................................ Date………………….. 3 Association of Business Mentors, 73 Temple Sheen Road, London SW147RS Registered Address: The White House, 19 Ash Street, Ash GU12 6LD Registered Company Number 753326 Limited by guarantee. Not for profit. How did you hear of the ABM? Nominating members: 1. 2. Referees: It is a prerequisite to have worked with at least ten businesses over a minimum of two years Name Referee Contact details 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Do you use: Terms and Conditions Client Contract Any requests or suggestions for Training, Benefits, topics for Professional Information Mornings or generally… 4 Association of Business Mentors, 73 Temple Sheen Road, London SW147RS Registered Address: The White House, 19 Ash Street, Ash GU12 6LD Registered Company Number 753326 Limited by guarantee. Not for profit. Payment details ABM fees are £25 per quarter via Standing Order (no VAT) Quarter starts are 1st of May, August, November and February For mid quarter starts include £12.50 with the initial payment Bank details: Sort code 207217 Account 23202070 Reference: Your name For payment queries contact Bob Morton [email protected] Please return your completed application via:  Scanned and email to [email protected]  Automatically with Docusign  Post to 73 Temple Sheen Road London SW147RS * Not the company registered address Thank you Office use only: Initial Fee received 5 References checked by Association of Business Mentors, 73 Temple Sheen Road, London SW147RS Registered Address: The White House, 19 Ash Street, Ash GU12 6LD Registered Company Number 753326 Limited by guarantee. Not for profit.