MEMBER 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.

If you prefer to submit your application and payment by mail, please click here to download the printable application form.

Required fields are marked with *

Thank you!

NOTE: IF YOU ARE INTERESTED IN A CORPORATE MEMBERSHIP, CLICK HERE.

MEMBERSHIP INFORMATION

Membership Level: *

Silver ($99) Gold ($150) Platinum ($250)

First Name:*

Last Name:*

Middle Initial:

Are you a Facebook member?

Yes No

If yes, what name is used:

If yes, what email address is used:

Are you a Twitter member?

Yes No

If yes, what name is used:

If yes, what email address is used:

EMPLOYMENT INFORMATION

Company:*

Title:

Address:*

City:*

State:*

Zip:*

Phone:*

Fax:

Cell:

Email:*

Website:

Business Category: *

Description of Your Business: *

(Maximum characters: 200)
You have characters left.

Logo:

Platinum Members Only.
Gold Members may upload a logo only if they are NOT uploading a photo.

PERSONAL INFORMATION

Address: *

City: *

State: *

Zip: *

Home Phone: *

Email: *

Photo:

Platinum and Gold Members Only.
Gold Members may upload a photo only if they are NOT uploading a logo.

Birthday: *

Place of Worship: *

Referral Source: *

What other professional organizations do you belong to? *

What are your expectations of becoming a member? *

What email address should we use for sending announcments? *

Please check off the areas in which you are interested in serving:

Leadership Team	Registration	Greeting Members/Guests
Special Projects	Missions	Donating Door Prizes
Other

Commitment:
I understand that the intent of this organization is to fellowship and network with other Christian business women. I agree to encourage and support other members through building relationships founded on biblical principals. Also, I give my permission to use the above information in the Membership roster to be placed on the Exceptional Women website. I also agree and understand that membership dues are non-refundable and non-transferable. Finally, I 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.*