Please complete all information below to be considered for membership.
Name of Member Who Nominated You for Potential Membership in CWI: Name:
Date of Application: Position/Title: Company Name: Address: City: State: Zip Code: Work Phone: Mobile Phone: Email Address: Birth Date: – - Select – - January February March April May June July August September October November December – - 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Educational Background – Please check one of the following: High School Diploma Some College Bachelors Masters PhD Number of Current Employees: Website Address:
Years in Business/Profession:
Type of Business (Your Business Category): Description of Company, Business and Products/Services (This information will be posted on the CWI membership directory listing): What’s your specialty and/or uniqueness in business? Describe the Types of Businesses and/or Companies You Have Worked With (types of businesses, location, size of companies, industry sectors, etc.): Describe Your Target Market (Types of companies/organizations/businesses you seek to do business with, size of targeted companies, key contact you target in a company, etc.):
Home Address: City: State: Zip Code:
Home Phone: Home Email Address:
Do you currently serve on the Board of Directors of any companies or non-profit organizations:
Yes No If yes, please list: List any professional organizations, trade groups, chambers of commerce, community organizations or networking groups you belong to: Previous Leadership Positions in Groups, Organizations, Associations or Professional Trade Groups (Please list name of club or organization and your leadership position title:
Describe the individuals and/or professionals you know that you anticipate inviting to CWI from your existing relationships:
What are you looking for by being involved in CWI? (Examples: Referrals, business/colleague partnerships, connections to other business professionals, career connections, etc.): How will you evaluate and/or determine whether your membership in CWI has been valuable?
Professional Level Membership: $350 – Annual Membership Fee + $69/month – Monthly Dues **Monthly Payment Plan Option – $99/mth for 1 year commitment
Executive Level Membership $350 – Annual Membership Fee + $200/month – Monthly Dues **Monthly Payment Plan Option – $230/mth for 1 year commitment
Upon membership vote and acceptance, a credit card will be required for payment of annual membership fee and monthly dues.
By submitting this application, I certify that all information is true and complete to the best of my knowledge. I hereby apply for membership in CWI and have read and understand the qualifications of membership and membership dues and fees. I understand that I may terminate my membership in CWI at any time with prior 30 day written notice and understand that the annual membership fee and monthly dues are nonrefundable. Upon submission of my membership application, I will receive notification of my acceptance into CWI and understand that membership is exclusive to the individual, not the organization. I understand that if I select the monthly payment plan option, I will be committing to a one year minimum membership in CWI. I further understand that my membership application may be denied after review and consideration and that my membership application is not a guarantee of acceptance. Upon membership approval, the annual membership fee and monthly membership dues are charged via credit card for the current month. Future monthly dues are charged on the first of each month. If membership is not accepted, no charges will be due or paid.
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