Apply for Membership

Membership Application

Please complete all information below to be considered for membership.

* Required Fields (or type none if applicable)

Individual Who Nominated You

Name of individual who nominated you for membership in CWI:

*If no nomination from an individual, an interview will be conducted for membership selection and approval.

Business Information

Your Name:*
Your Title:*
Company Name:*
Address:*
City:*
State:*
Zip Code:*
Work Phone:*
Mobile Phone:*
Email Address:*
Birth Month*
Birth Day*
Educational Background – Please check one of the following:*
Current Number of Employees:*
Website Address:*
LinkedIn Profile Page:
Facebook Page:
Twitter Handle:
Years in Business/Profession:*
Type of Business*

Professional Experience

Describe your current role, position and duties. Describe your current profession and/or business/company. (this information will be posted in the CWI membership directory):*
List your top five proudest business accomplishments:*

Supporting Others

Describe how you intend to be an advocate and supporter of professional women, including how you will support other members and how you will be a resource to professional women who lead in business.*

Finding Value in CWI

Describe how CWI and our members can be of great support and value to you? What are you looking for by being involved in CWI? (Examples: resources, shared business experiences, business assistance, referrals, introductions, business/colleague partnerships, connections, camaraderie, career assistance, fresh new ideas, corporate connections, peer-to-peer advice, etc.):*
How will you evaluate and/or determine whether your association in CWI has been valuable?*

Signature & Membership Agreement

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 requirements of membership. I understand that I may terminate my membership in CWI at any time with prior 30 day written (email) notice. Upon submission of my membership application, I will receive notification of my acceptance into CWI or a request for an interview. 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 selection and acceptance, a credit card will be required for payment of initiation fee and monthly dues, depending on the level of membership.

By submitting my name and applying for membership, my execution of a facsimile copy of my signature shall have the same force and effect as execution of an original, and a facsimile signature shall be deemed an original and valid signature.

Signature - Type Name Here:*
By checking yes, I have read and understand the membership agreement and requirements of membership. I understand that once I have been voted in to CWI I may terminate my membership at any time with prior 30 days written (email) notice. I further understand that execution of my facsimile signature shall be deemed my original and valid signature.*