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 RegionInland Empire Market RegionNational Market RegionIndividual Who Nominated You for Membership Name of individual who nominated you for membership (if none, enter none)*About You Your First and Last Name* Your Professional Title* Your Company Name* Your Address* Your City* Your State* Your Zip Code* Your Work Phone* Your Mobile Phone* Your Email Address* Your Birth Month*Select valueJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Your Birth Day*Select value01020304050607080910111213141516171819202122232425262728293031 Educational Background – Please check one of the following:*High School DiplomaBachelorsMastersPhD Current Number of Employees in the Company* Your Website URL Your LinkedIn URL Your Facebook Page URL Your Other Social Media URL Years in Business/Profession:* Business Category:*Professional Experience Describe briefly your current role, position and duties and what business you're in. (Note: This information will be published in the Membership Directory.):*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 time and membership in CWI has been valuable?*Supporting Others Describe how you intend to be an advocate and supporter of professional women, including how you will support other members.*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 have read and understand the cancellation, payment, pricing and refund policy. 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 payment 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 have read and understand the cancellation, payment, pricing and refund policy. I further understand that execution of my facsimile signature shall be deemed my original and valid signature.*Yes Please upload your professional picture:SubmitReset Attend An Event As Our VIP and GuestJoin Us!
