Membership Form

Membership Form

Women in Power Empowering
Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Email *
example@example.com
Phone Number
Please enter a valid phone number.
Date of Birth (dd/mm/yyy)
How did you hear about our organization?
To complete membership select an Annual Membership Level and Preferred Frequency of Giving
Categories: All

All

$500 Membership Level

$750 Membership Level
prev next ( X )
$500 Membership Level

Monthly Frequency for $500 Annual Commitment Initial contribution to execute membership based on membership level and contribution frequency. (Full payment for annual, 25% for quarterly, or $50 for monthly $500 level)
$ 50.00

Quarterly Frequency for $500 Annual Commitment
$ 125.00

Annual Frequency for $500 Level (one-time upfront payment)
$ 500.00

$750 Membership Level

Monthly Frequency for Annual $750 Commitment Initial contribution to execute membership based on membership level and contribution frequency. (Full payment for annual, 25% for quarterly, or $75 for monthly $750 level)
$ 75.00

Quarterly Frequency for $750 Annual Commitment
$ 187.50

Annual Frequency for $750 Annual Commitment (one-time upfront payment)
$ 750.00

Total

$ 0.00
Your membership does not become official until receipt of your first contribution. The amount of the contribution required is dependent on the frequency selected. If you select "annually" the full amount is due, "quarterly" 25% is due, or monthly $50 is due for the $500 level or $75 is due for the $750 level (on a 10-month cycle).

Members will receive a PayPal invoice based on the frequency selected (Annual, quarterly, or monthly). Please email wipetreasurer@gmail.com with any questions or concerns about payments or if you would like to set up auto-debit through PayPal.

Payment Methods

Debit or Credit Card

First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Please click one of the PayPal options to complete payment and submit the form.

Should be Empty:

Now create your own Jotform - It's free! Create your own Jotform