Membership Application

1

What is your name?* This field is required.

First Name

Last Name

2

What is the name of your company?* This field is required.

4

What is your email address?* This field is required.

myname@example.com

5

What is your LinkedIn profile?* This field is required.

www.linkedin.com/in/user

6

Where are you located?* This field is required.

City

State

Country

7

How did you hear about our community?* This field is required.

Referral

Event

Other

8

Who referred you to us?We would love to know so we can thank them.

9

Which of the following best describes why you are interested in joining the My Perimeno-Posse community?* This field is required.

10

Thank you for your Request to Join the My Perimeno-Posse community!

As a next step, we will review your Request.

Once approved, you will receive a follow-up email similar to the below.

This will take you to the payment page to finalize your membership.

Cost is $10.18/month to align with 10/18 World Menopause Awareness Day ($122.16 annually)