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 in CWI:About You 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: Instagram URL Link: 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.*YesSubmitReset Attend An Event As Our VIP and Guest Join Us!
