CORPORATE SIGNUP

Important: Please fill in every field in order for your application to be processed properly. You will be contacted within 5 business days to verify whether there is an opening in your business category. If not, your payment will be refunded to you.

Required fields are marked with *

Thank you!

COMPANY INFORMATION

Membership Level: *	Business Level ($400) Executive Level ($750)

Company Name:*
Address:*
City:*
State:*
Zip:*
Phone:*
Fax:
Website:
Business Category: *
Description of Your Business: *	(Maximum characters: 200) You have characters left.
Referral Source: *
Logo:	Platinum Members Only. Gold Members may upload a logo only if they are NOT uploading a photo.
EMPLOYEE INFORMATION

Member #1

Name:
Title:
Email:
Birthday:
Photo:



Member #2

Name:
Title:
Email:
Birthday:
Photo:



Member #3

Name:
Title:
Email:
Birthday:
Photo:



Member #4

Name:
Title:
Email:
Birthday:
Photo:
Commitment: As an authorized representative of the above named business and individuals, we understand that the intent of this organization is to fellowship and network with other Christian business women. Also, I give permission to use the above information on the Exceptional Women website. I understand that membership is for a one year term and that dues are non-refundable. Finally, we agree to comply with the by-laws, rules and regulations of Exceptional Women either now or to become effective at a future date.

I have read the Commitment Statement.*