Membership Application Please complete all information below to be considered for membership. * Required Fields (or type none if applicable)Market Region You Are Joining Joining:*San Diego Market RegionOrange County Market RegionLos Angeles Market RegionIndividual Who Nominated You Name of individual who nominated you for membership in CWI:Nominee InformationBusiness Information Your Name:* Your Title:* Company Name:* Address:* City:* State:* Zip Code:* Work Phone:* Mobile Phone:* Email Address:* Birth Month*Select valueJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Birth Day*Select value01020304050607080910111213141516171819202122232425262728293031 Educational Background – Please check one of the following:*High School DiplomaBachelorsMastersPhD Current Number of Employees in the Company:* Website URL:* LinkedIn Profile URL Link: Facebook Page URL Link: Twitter URL Link: Years in Business/Profession:* Type of Business or Profession (this will be used in the CWI membership directory):*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 AgreementBy 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.*YesSubmitReset Attend An Event As Our VIP and Guest Join Us!
