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Personal Information
Full Name (First, Middle, Last)
 City
Male
 Female		 State
Home Address
 		Zip Code
E-mail Address
 		 
 
Employment
Employer
 		Office Phone
Address
 		Fax
City
 		Email
State
 		Job Title
Zip Code
 		 Year Employed
 
Job Function
Accountant Corporate Manger Marketing/Brand, Product Mgr
Administrator Education/Education Admin Personnel/HR/Labor Relations
Advertising Engineer/Technical/Machinist Purchase Agent/Buyer
Architect Entrepreneur Sales (Specify Type below)
Attorney/Legal Staff, Support Financial manager/Office  
Banker Health Care Administrator Strategic Planner
Clerical Insurance Professional Systems/Information System
Corporate Analyst Management Consultant Other
 
Industry
Accounting Engineering/Electronics/Technology/Science Oil/Petroleum
Advertising Financial Services Personal Services – laundry, cleaners, supplies, counseling, etc.
Agriculture/Forestry/Veterinary Government/Military/Pubic Service/Non Profit Real Estate
Architecture/Construction/Mining Health/Medicine/BioTech Religion
Arts/Graphics Hotel/Lodging/Travel Restaurant/Food Service/Cater
Automotive Insurance Sports/Entertainment
Business Services-employment agencies, maintenance, rentals, collections Legal/Investigative/Jurisprudence Systems/Information Systems/Research
Communications/Media/Publishing/Public Relations Management Consulting Transportation
Consumer Retail Manufacturing/Processing/Repair Wholesale Trade/ Distribution/Warehousing
Education Marketing Other (please specify below)
Environmental Museum/Library/Archival/Zoo  
 
Education
Undergraduate School
 		Graduate School
City
 		City
State
 		State
Class of
 		Class of
Degree
 		Concentration
Major
 		Degree

Committees
Please specify the local chapter committees you would like to work with (Number in order of preference)
Economic Development Membership Fund Raising
Public Relations Community Relations Student Affairs
Corporate Reception Finance Programs
Leaders of Tomorrow Corporate Relations Advisory
Communications- Technology    
 
Membership
Please review the criteria for the three types of membership described below and pick one. Memberships are based on the calendar year. Membership dues are paid annually, unless you are Full Life or an Associate Member.
 
Full Member
Anyone with a MBA degree or other advanced degree (MS, MHA, MPA or Ph.D., MSW, etc)

Full Member ($125)
Full Life ($1,000)
Full Life Installments
(3 annual payments of $350)

 Student Member
Anyone actively pursuing an advanced management degree

Student Member ($60)

 Associate Member
Anyone distinguished in business because of management experience or entrepreneurship

Associate Member ($125)
Associate Life ($1,000)
Full Life Installments
(3 annual payments of $350)
 
Mail Preference
Home
Work		 Membership Type
New Membership
Renewal

If you are renewing your membership, what year did you first join NBMBAA
 

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www.bayerhealthcare.com

www.schering-plough.com

www.wyndhamworldwide.com

www.kraft.com

www.prudential.com

www.jnj.com

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National Black MBA Association
New Jersey Chapter
P.O. Box 28023
Newark, NJ 07101
bmba-info@nbmbaa-newjersey.org