Gold Member Status Report

To qualify for the Gold Badge Club you must sponsor a minimum of 6 members to BNI Central Virginia Region.
Please complete the following form. Once verified, the badge will be awarded to your chapter’s leadership team by your chapter director.
BNI Member Name *
First Last
Chapter's Name *
Company Name & Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Email *
Phone *
### - ### - ####
1st Member That I Sponsored *
2nd Member That I Sponsored *
3rd Member That I Sponsored *
4th Member That I Sponsored *
5th Member That I Sponsored *
6th Member That I Sponsored *
Additional Comments for Regional Office:
Date Application is being submitted *
MM / DD / YYYY
Thank you for submitting your application. The regional office will need time to verify your information that you have submitted. You may be contacted by the regional office during the verification process.

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