Membership Registration
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?
*
Please Select
Website
Referred
Magazine
Social Media
Other
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?
*
Please Select
Yes
No
Not Sure
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
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