Membership Application Form Please See our Membership Page for Full Explanation on Criteria and Calculation for Entry. Last Name * First Name * Title Company Name * (Enter your organization name) Professional Bio Profile Photo 900 x 1200 Drop your image file here or click to upload Choose File Maximum upload size: 134.22MB Upload a jpg or png image that is at least 900 px wide x 1200 px high Contact Info Click Section Title to Add Contact Info Address 1 Address 2 City State / Province AB AK AL AR AZ BC CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MB MD ME MI MN MO MS MT NB NC ND NE NF NH NJ NM NS NT NV NY OH OK ON OR PA PE PQ RI SC SD SK TN TX UT VA VT WA WI WV WY YT Zip Code Phone PLEASE ENTER PHONE NUMBER LIKE THIS EXAMPLE: 888-123-4567 Phone Ext. Fax PLEASE ENTER PHONE NUMBER LIKE THIS EXAMPLE: 888-123-4567 Mobile Phone Available Yes No Mobile Phone PLEASE ENTER PHONE NUMBER LIKE THIS EXAMPLE: 888-123-4567 Home Phone Available Yes No Home Phone PLEASE ENTER PHONE NUMBER LIKE THIS EXAMPLE: 888-123-4567 Your Email * Put your contact email address here,NOT the organization's email address. Website URL Example: http://mywebsiteaddress.com LinkedIn URL Annual Billings Click Section Title to Add Annual Billing Info Pinnacle membership requires a minimum of 5-years of agency recruiting experience with at least 3 out of those 5 years personal billing above $500k/annually. Please enter your personal billing amounts for the last 5 years. Select Year 1 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2024 2025 2026 2027 2028 2029 2030 Annual Billing $ - Year One $ (Most Recent Calendar Year) Select Year 2 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2024 2025 2026 2027 2028 2029 2030 Annual Billing $ - Year Two $ Select Year 3 * 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2024 2025 2026 2027 2028 2029 2030 Annual Billing $ - Year Three $ Select Year 4 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2024 2025 2026 2027 2028 2029 2030 Annual Billing $ - Year Four $ Select Year 5 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2024 2025 2026 2027 2028 2029 2030 Annual Billing $ - Year Five $ Locations & Industries Click Section Title to Add Location(s) & Primary Industry / Industries Location Americas Asia-Pacific Atlanta GA Australia California Canada Chicago/Chicagoland East Coast U.S. Eastern U.S. Global Houston TX Iowa Kansas City Latin America Memphis TN Mexico Mid Atlantic U.S. Midwest U.S. Minneapolis/St. Paul MN Nationwide/United States New Zealand North America Northeast U.S. San Antonio TX Singapore South U.S. South America Southeast U.S. Southwest U.S. Texas United Kingdom Washington DC Area Western U.S. Industry Accounting Accounting/Tax Accounting All Industries Administrative Support Analytics Apparel Automotive Automotive/Autonomous Driving Systems Banking Banking/Investment Banking Biotech Construction/Construction Management Consumer Packaged Goods/CPG Consumer Products Consumer Marketing Defense/Aerospace Ecommerce Electrical Wholesale Distribution Energy Engineering Engineering/Petroleum Engineering Environmental Finance/Financial Services Forest Products General Government Health Care Health Care/Health Care Technology Health Care/Long Term Health Care Hospitality Hospitality/Hotel Human Resources Industrial Services Insurance Intellectual Property Attorneys Legal Life Sciences Lighting Design Management Manufacturing Manufacturing/Lighting Market Research Marketing Medical/Medical Technology Medical Device Mergers & Acquisitions Microelectronics Oil & Gas Operations Pharmaceutical Raw Materials Raw Materials/Ingredients Real Estate Development Renewable Energy Retail Sales Sales & Marketing Senior Living Services Software Software/Start-Up Software/Software Sales Software/SAP Technology/Cybersecurity Technology/Data Storage Technology/Digital Technology/IT Technology Technology Sales Textiles/Non-Wovens Wholesale Admin Only Show on Home Page No If you are human, leave this field blank.