Register Private Networking Circle

Important: This form should be completed by the Circle's Primary Organizer - who will be the first Circle Organizer listed - and they will be PHB's primary contact. Please use the following links to: Update a Circle | Cancel a Circle | Contact Admin

Name of Networking Circle (ex: Silicon Valley Networking Circle): *

Type of Circle: *

Day of Week: *

Time of Circle (ex: 5:55 - 8pm): *

Your Time Zone: *

Frequency of Circles (ex: every 2nd and 4th Tues): *

General Location of Circle (City/state, etc): *

About Circle Organizer (Primary PHB Contact)

First Name: *
Last Name: *

Your Title: *

Business Name: *

Phone *

Email: *

(If applicable) About Circle Co-Organizer #1

(If Applicable) Name Of Co-Organizer #1

(If Applicable) Title of Co-Organizer #1:

(If Applicable) Business Name of Co-Organizer #1:

(If Applicable) Phone of Co-Organizer #1:

(If Applicable) Email of Co-Organizer #1:

(If applicable) About Circle Co-Organizer #2

(If Applicable) Name of Co-Organizer #2:

(If Applicable) Title of Circle Organizer #2:

(If Applicable) Biz Name of Co-Organizer #2

(If Applicable) Phone of Co-Organizer #2:

(If Applicable) Email of Co-Organizer #2:

How to Reach Your Circle

(For PHB's "Find a Circle" page) What email should ladies use to ask you if they can be a 1X FREE guest at an upcoming Circle? *

Other Comments:

Please use the following links to: Update a Circle | Cancel a Circle | Contact Admin