Membership Application — Leaders of the New Millennium

First & Last Name *

Email *

Phone

Membership Type

City

Country

Area of Interest

Why do you want to join? Tell us about yourself.

Referred By (optional)

📸 Photo, Video & Media Consent

From time to time, Leaders of the New Millennium takes photographs, video, audio recordings, and other media at our events, meetings, and programs. These may be used for our website, social media (Facebook, Instagram, LinkedIn, X/Twitter, TikTok, YouTube), newsletters, press releases, marketing materials, grant reports, and other promotional or educational purposes. Your name may also appear alongside the media. You will not be compensated for the use of your name, image, voice, or likeness.

✅ YES — I consent to LNM using my name, photo, video, voice, and likeness in social media, marketing, and promotional materials. 🚫 NO — I do not consent. Please do not publish my image or name in public materials. (You can still be a member; we'll keep you out of group photos used publicly.) 📝 LIMITED — You may use group photos that include me, but please do not tag me by name or feature my image in solo/spotlight posts.

You can withdraw or change this consent at any time by emailing ltnmja@gmail.com.

✍️ Electronic Signature Authorization

By signing below, I certify that the information provided in this application is true and accurate to the best of my knowledge. I authorize Leaders of the New Millennium to review my application and contact me regarding my membership. I understand that membership is subject to approval, and I agree to uphold the values, code of conduct, and bylaws of the organization. I consent to the use of this electronic signature as the legal equivalent of my handwritten signature.

I have read and agree to the authorization above. *

Type Your Full Legal Name *

Date

Draw Your Signature *

Sign here with your mouse or finger

Your information is kept confidential and used only for membership review.
Questions? Email us at ltnmja@gmail.com

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Application Received!

Thank you for applying to Leaders of the New Millennium. Our membership team will review your application and reach out to you soon at the email you provided.