CWN NEW Membership Application

CWN New Membership Application

Thank you for applying for membership in CWN.
Name*

First NameLast Name
Company*
Position*
Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail*
Mobile Number

Area CodePhone Number
Work Number

Area CodePhone Number
Website
Please check WHICH phone number(s) you want included in the online Directory*

Work PhoneMobile Phone
Job Description*
Professional/Business Affiliations*
Volunteer/Civic Activities*
Code of Conduct*

By checking this box I understand the membership responsibilities and agree to abide by the Code of Conduct as described in the CWN By-Laws
I want to receive emails from CWN about events and member announcements.*

YesNo
Application Date*

MonthDayYear
One annual membership level is available:

General: $125/year includes scholarship donation, name & business included in the CWN website directory, and one free spotlight for the member’s business via social media post
Your Membership Level*

Standard $125
Should be Empty:

CWN New Membership Application