The Virtuous Woman Project Membership Registration Form

Full Name *

First Name Last Name

Date of Birth *

Member MM/DD/YYYY Spouse MM/DD

What is Your Favourite Colour(s)? *

Spouse's Name *

First Name Last Name

Anniversary Date *

MM/DD

Children Information

First and Last Names

Date of Birth

Gender

Favourite Colour

Age

1

2

3

4

5

Address *

Street Address

Post Office

City Parish

Country

Phone Number *

E-mail

example@example.com

How did you hear about us? *

What motivated your interest in the vision of The Virtuous Woman Project?

What do you hope to achieve as a member of The Virtuous Woman Project?

Do you believe you have identified your PURPOSE? *

Do you have a project/purpose idea you will need support with?

Do you have any special requests that you would like to be considered?

Membership Level

Pearl @ JMD$1000/mth. (USD$10/mth.) Diamond @ JMD$2000/mth. (USD$20/mth.) Ruby @ JMD$5000/mth. (USD$50/mth)

Payment Option

Cash Credit Card PayPal

Q & A Appointment

Please give reference of any two women you believe would benefit from the vision:

Full Name

Address

Contact Number

1

2

Signature

Clear