WiN Membership Application

Applicant Information

To apply for a WiN membership, please complete ALL fields.
Name*

First NameLast Name
Company
Title/Position*
Website
Primary Email*
example@example.com
Secondary Email
example@example.com
Work Phone

Area CodePhone Number
Cell Phone

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState

Zip CodeCountry

Member Directory

I authorize Women in Nonfiction to publish the contact information checked below in a confidential directory available only to WiN members.
WORK PHONECELL PHONEPRIMARY EMAILSECONDARY EMAIL

Membership

We’ve paused annual membership fees during the pandemic, so you can join WiN now at no charge. When things get more back to normal, and we can resume in-person events, we’ll contact you about converting your membership to a normal, paid level.
Pandemic Pause (Free)

Acceptance and Authorization

By initialing below, I affirm that all information provided in application is accurate and up to date.
Initials*
Date*

MonthDayYear
Comments
Do you have any questions, or is there anything we should know about your application?
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