WIISE Membership Form
Welcome to WIISE Woman! We're thrilled to have you join our empowering community. To ensure you make the most of your WIISE experience, kindly take a moment to complete our membership form. Your information will help us tailor our support and resources to meet your unique needs. Click the link below to get started:
Name
First Name
Last Name
Company Name
Title
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
What Gender do you identify with
Female
Male
Non-Binary
Prefer not to say
Other
Please select your age range:
18-24 years
25-34 years
35-44 years
45-54 years
55-64 years
65+
What best fits your role in the insurance industry?
Independent Agency Owner
Independent Agency Agent / Staff
Captive Insurance Carrier Agent / Staff
Association
InsurTech
Non Profit Leader
How long have you been in the insurance industry?
1-3 years
4-7 years
8-15 years
Over 15 years
Do you hold any professional certifications related to insurance (e.g., CPCU, CIC)?
Are you a member of any professional insurance associations or organizations? If so, please list
How did you hear about WIISE Woman?
Social media
Referral from a friend
Online search
Event or workshop
Other
What challenges or barriers do you feel are unique to female professionals in the insurance industry that this group could address?
What aspects of personal development are you most interested in?
Career growth
Skill enhancement
Work-life balance
Networking opportunities
In your opinion, how well-represented are women in leadership roles within the insurance industry?
Would you be open to participating in a mentorship program, and if so, in what capacity? Please choose the option that best reflects your interest:
Sure thing! I'm ready to unleash my wisdom as a mentor.
Absolutely! I'm on a quest for guidance as a mentee.
Why not both? I'm up for a mentoring mixtape – double the fun!
Currently rockin' that mentorship stage
I'm already soaking up wisdom as a seasoned mentee.
Hmm, intriguing! I might consider it.
Nah, not my cup of tea. I'm on my own adventure for now.
Are you interested in additional opportunities to contribute, such as being a guest speaker, participating in a podcast, or other impactful roles within our community? Let us know how you'd like to contribute and shine within WIISE.
Please Rank the following professional development resources
1 Least Valuable - 10 Most Valuable
Workshops
1
2
3
4
5
6
7
8
9
10
Webinars
1
2
3
4
5
6
7
8
9
10
Certification Course
1
2
3
4
5
6
7
8
9
10
Guest Speakers
1
2
3
4
5
6
7
8
9
10
Podcast Interviews
1
2
3
4
5
6
7
8
9
10
Mentorship Program
1
2
3
4
5
6
7
8
9
10
What topics would you like to see covered in future WIISE events or resources?
Leadership and career advancement
Health and wellness
Personal finance
Technology trends
Other
What kind of content would you like to see more of on the WIISE platform?
Success stories
Skill-building resources
Industry insights
Community spotlights
What is your Primarty reason for joining WIISE
Mentorship Opportunities
Networking Opportunites
Professional Development
To give back to the community
How often and for how long would you prefer to engage with WIISE Woman's events? Please choose up to two options that best suit your preferences:
Weekly for 30 minutes to an hour
Bi-weekly for 30 minutes to an hour
Monthly for 30 minutes to an hour
Occasionally for special events and workshops
Other
Do you have any personal stories or experiences that highlight the positive impact of collaboration between men and women in professional or personal settings?
Thank you for being a part of WIISE Woman. We look forward to celebrating your journey of growth and empowerment together!
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