CWN NEW Membership Application

CWN New Membership Application

Thank you for applying for membership in CWN.
Name *

First Name Last Name
Company *
Position *
Business Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
E-mail *
Mobile Number

Area Code Phone Number
Work Number

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

Work Phone Mobile 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. *

Yes No
Application Date *

Month Day Year
Two annual membership levels are available:

General: $55/year includes scholarship donation and name & address included in the CWN website directory

Premium: $100/year includes scholarship donation, name & address included in CWN website directory, logo on CWN website, and one free annual spotlight for you via social media. Please upload a jpg of your logo below.
Your Membership Level

General: $55 Premium: $100
Please upload a jpg of your logo if you joined as a Premium Member

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CWN New Membership Application