Presidents Club Directory Form
For CWIMA Presidents Club Members: Share your media fields, collaboration interests, and directory preferences.
SECTION 1: Member Information
Please provide your contact and membership details.
Full Name
*
First Name
Middle Name
Last Name
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.
Email Address
*
example@example.com
Website
Facebook
Instagram
Linkedin
Are you a current Presidents Club member?
*
Yes
No
Membership Level
*
Gold Member
Silver Member
This form is for Presidents Club members only. Please contact CWIMA administration for membership upgrade information.
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SECTION 2: Media Field Selection
Select Your Primary & Secondary Media Fields. Please select all areas in which you actively serve or lead.
Please select all that apply
*
Social Media Strategist / Influencer
Television (Host, Producer, Network Executive)
Film (Director, Producer, Screenwriter, Actor)
Podcasting
Radio Broadcasting
Digital Media Content Creator
Print Media (Magazine, Newspaper, Editorial)
Publishing (Author, Editor, Literary Agent)
Please select all that apply Continued..
*
Music Industry
Worship Arts
Entertainment Industry Professional
Public Relations / Communications
Marketing & Branding
Creative Arts (Photography, Graphic Design)
Ministry Media Director
Media Entrepreneur / Agency Owner
Other
SECTION 3: Collaboration Interests
Select the types of collaboration you are interested in.
What type of collaboration are you seeking?
Joint Media Projects
Speaking Opportunities
Podcast Guesting
Book Collaborations
Film / TV Partnerships
Prayer & Accountability Circle
Mentorship (Seeking)
Mentorship (Offering)
Strategic Partnerships
Kingdom Business Networking
Volunteer at CWIMA events
Other
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SECTION 4: Directory Permission
Presidents Club Private Directory Authorization
Do you give CWIMA permission to include your professional information in the private Presidents Club directory (accessible only to Presidents Club members)?
*
Yes, I give permission to be included.
No, I prefer not to be listed at this time.
If listed, what information may we include?
Name
Email
Phone
Website
Social Media Links
Media Specialty
Short Professional Bio
Headshot for Directory
Browse Files
Drag and drop files here
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This will be used for Directory purpose only!
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Short Professional Bio (100–150 words)
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SECTION 5: Spiritual Alignment & Leadership Commitment
Affirm your alignment with CWIMA’s mission and values.
As a Presidents Club member, I affirm that I will collaborate in alignment with CWIMA’s mission, biblical values, and spirit of excellence.
*
I Agree
Comments / Notes:
SECTION 6: Signature
Please provide your digital signature to complete this form.
Digital Signature
*
Submit
Submit
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