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Membership Application Form

"*" indicates required fields

Name*

Full

Sponsor*

Business Name*

Category*

Home Address*

Street Address Address Line 2 City ZIP Code

Business Address*

Street Address Address Line 2 City ZIP Code

Business Phone*

Personal Phone*

Email*

Indicate best phone for MWBN and member contact*

Business Phone

Personal Phone

About You

Birthday (Month)*

Birthday (Day)*

Education Level/Degree(s)*

High School

Some College

Bachelors

Masters

Doctorate

Other

If Other Education, Please List Here

Professional Designations*

Other Professional Memberships/Affiliations*

Years in Current Industry*

Years at this Job*

Volunteer Affiliations*

Spouse/Partner/SO

Have you ever been convicted of a felony?*

Yes

No

Have you filed personal/professional bankruptcy in the last 10 years?*

Yes

No

About Your Business

Your Title*

Responsibilities*

Description of your Business*

Website*

Social Media

Facebook

Instagram

Twitter

Other

List all Sales Organization/Franchise/Wholesale Affiliations*

Describe Your Ideal Client(s)*

Your Ideal Referral Partner(s)*

Do you own, work for, sell, or participate in any other additional businesses?*

Yes

No

If yes, please describe*

Why do you want to be a member of MWBN?*

What can you offer the MWBN organization?*

Consent*

I agree to the membership policy.

I hereby apply for membership in Memorial Women’s Business Network. I have read and understand the By-Laws of the organization and agree to abide by them should membership be granted. I also acknowledge that if I wish to change business categories in the future, I will submit a category change application for the MWBN Board to formally review and vote upon.

Signature*

Date*

Month

Day

Year

NOTE: This application is not complete without a current resume/bio and sponsor form. MWBN Board will review your application and will notify you of acceptance status. Upon acceptance Pro-rated dues for the remainder of the year will be due and payable on or before the next regular meeting.

Comments

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