Young Professionals Application

Individual members under 46 years of age have the option to fulfill their commitment within a longer period in accordance with the schedule approved by the Board of Trustees.

Online submissions are encouraged. If you prefer to print the application and mail it in you can download here.

Personal Information

Name

First Name

Last Name

Names Day / Middle Name / Saint

Date of Birth

YYYY

Home Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Personal Email

Phone

(###)

###

####

Parish Affiliation

Parish Name, City, State

Name of Spouse

First Name

Last Name

Spouse Names Day / Middle Name / Saint

Spouse Date of Birth

YYYY

Name of Children / Date of Birth

Enter names of all children and corresponding date of birth

Business Information

Company Name

Title

Occupation

Business Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Business Phone

(###)

###

####

Business Email

Contact Information

How did you learn about Leadership 100

Brochure

The Leader

Website

From a Member

Other

Leadership Commitment

Under what name(s) should this gift be listed

We/I hereby pledge my/our gift of $100,000 starting

YYYY

to be paid in the installment of:

Signature of Applicant

Type Name

Name of Sponsor

Young Professionals Application

The Archbishop Iakovos Leadership 100 Fund

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