Signup Form

Membership Application

To apply for membership please complete all questions.
Name*

First NameLast Name
Gender*

FemaleMalePrefer not to say
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail*
example@example.com
Cell Number*
Format: (000) 000-0000.
What is your job title? (owner, executive, etc)*
Are you a business owner?*

YesNo
If yes, what is the name and type of your business? (If you don't own a business please put N/A)*
Please provide your business website URL (If not applicable please put N/A)*
What is your experience level?*

Under 1 year as an executiveUnder 1 year working full-time for my own business1-5 years in an executive position1-5 years working full-time for my own business2-5 years as an executive2-5 years working full-time for my business5+ years as an exectutive5+years working full time for my businessMy business is just my side-hustle but annual income is still over $50,000N/A
What is your current annual income?*

Under $50,000$50,000-$100,000$100,000-$250,000$250,000+
What are you looking for from Lady Boss Alliance? (Select all that apply)*

Networking: building relationships with other female entrepreneurs and executivesEducation: sharpen your business and entrepreneurial skillsCommunity: support from like-minded female business ownersSafety: freedom to express your unique gifts and talents
Marketing permissions:*

I agree to allow marketing communication from Lady Boss Alliance. (This includes our newsletters and event announcements. We never sell or share your information with third party companies)No, I do not want to receive marketing communication from Lady Boss Alliance.
Signature
Please verify that you are human*
Signature date
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Membership Application