First Name *

Last Name *

Organization *

Job Type *

Your Role/Job Title

Years with the Company *

Email *

Address Line 1 *

Address Line 2

City *

State *

Enter required value

Country *

Enter required value United States Canada Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos Islands Colombia Comoros Congo Congo Democratic Republic of Cook Islands Costa Rica Coted Ivoire Croatia Cuba Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea Bissau Guyana Haiti Heard Island and Mc Donald Islands Holy See Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isleof Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea Democratic Peoples Republic Korea Republic of Kuwait Kyrgyzstan Lao Peoples Democratic Republic Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Barthelemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania Thailand Timor Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Venezuela Viet Nam Virgin Islands British Virgin Islands US Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Sark

Phone *

What industry is your company in? *

Company Federal Tax Classification

Individual/sole proprietor or single-member LLC

C Corporation

S Corporation

Partnership

Other

Number of company locations/subsidiaries? *

List of company locations: *

Desired location/city for a chapter OR type of chapter (Veterans, Students, etc.) *

Do you have contacts throughout your potential chapter area? *

Enter required value Yes No

Can you commit to having at least one member of your team at our monthly Chapter Committee meeting? *

Enter required value Yes No

Short Answer: Please complete a Chapter Plan and submit to: info@esportsta.org *

Please make a copy of the Chapter Plan Template and submit the completed plan with your application.

Overview: Include a summary of your inspiration, focus, and local community impact for your ESTA Chapter mission.

Objective: Include goals regarding, but not limited to board member and member recruitment, engagement, attendance, and meetings/events for your ESTA Chapter.

Timeline for Execution: Include details and a timeline for your first meeting/event launch (virtual or in-person) and a timeline for ongoing chapter meetings.

Opportunities and Growth: Include all other pertinent information about your ESTA Chapter such as, but not limited to, board/committee governance structure, sponsorships, and community interest. Please provide a list of any individuals currently interested in joining this chapter as a chapter leader or board member.

Email your Chapter Plan to info@esportsta.org.

Initial below.

Agreement *

I understand that the granting of a chapter is at the sole discretion of the Esports Trade Association (ESTA) and that acceptance of this application is not a granting of a Chapter. I understand that any information I received from ESTA, or from any employee, agent, board member, or member is highly confidential, has been developed with a great deal of effort and expense to ESTA, and is being made available to me solely because of this application. I agree that I shall treat and maintain all confidential information as confidential, and I shall not, at any time, without the express written consent of the Esports Trade Association, disclose, publish, or divulge any confidential information to any person, firm, corporation, or entity, or use any confidential information, directly, for my own benefit or the benefit of any person, firm, corporation, or other entity, other than for the benefit of ESTA.

Initial below.

Signature and Date *

By typing your Name and Date, you certify that all information is true and accurate.