CWI Application Form

Company Information

Nominated By:   Minimum not met  Too many characters   

Name:   Minimum not met  Too many characters   

Date:   Minimum not met  Too many characters   

Position/Title:   Minimum not met  Too many characters   

Company Name:   Minimum not met  Too many characters   

Address:   Minimum not met  Too many characters   

City:   Minimum not met  Too many characters   

State:   Minimum not met  Too many characters   

Zip Code:   Minimum not met  Too many characters   

Work Phone:   Minimum not met  Too many characters   

Mobile Phone:   Minimum not met  Too many characters   

Email Address:   Minimum not met  Too many characters    Invalid format

Birth Date: - - Select - - JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember    - - 12345678910111213141516171819202122232425262728293031   

Website Address:   Minimum not met  Too many characters   

Type of Business:   Minimum not met  Too many characters   

Description of Business and Products/Services Your Company Provides:   Minimum not met  Too many characters   

Years in Business/Profession:   Minimum not met  Too many characters    Invalid format

Number of Employees:   Minimum not met  Too many characters    Invalid format

Personal Information

Home Address:   Minimum not met  Too many characters   

City:   Minimum not met  Too many characters   

State:   Minimum not met  Too many characters   

Zip Code:   Minimum not met  Too many characters   

Home Phone:   Minimum not met  Too many characters   

Home Email Address:   Minimum not met  Too many characters    Invalid format

Professional Exprience

Do you currently serve on the Board of Directors of any companies or non-profit organizations: Yes     No   

List any professional organizations, trade groups, chambers of commerce, community organizations or networking groups you belong to:   Minimum not met  Too many characters   

Describe the individuals and/or professionals you know that you anticipate inviting to CWI from your existing relationships:   Minimum not met  Too many characters   

What you seek from CWI

What are you looking for by being involved in CWI? (Examples: Referrals, business/colleague partnerships, connections to other business professionals, career connections, etc.):   Minimum not met  Too many characters   

Type of Membership Applying For

Professional Level Membership:
Annual Membership Fee:$350
Monthly Dues:$350

Executive Level Membership
Annual Membership Fee:$350
Monthly Dues:$200

Payment Information

Upon membership vote and acceptance, a credit card will be required for payment of annual membership fee and monthly dues.

Signature & Agreement

By submitting this application, I certify that all information is true and complete to the best of my knowledge. I hereby apply for membership in CWI and have read and understand the qualifications of membership and membership dues and fees. I understand that I may terminate my membership in CWI at any time with prior written notice and understand that the annual membership fee and monthly dues are nonrefundable. Upon submission of my membership application, I will receive notification of my acceptance into CWI and understand that membership is exclusive to the individual, not the organization. I further understand that my membership application may be denied after review and consideration and that my membership application is not a guarantee of acceptance. Upon membership approval, the annual membership fee and monthly membership dues are charged via credit card for the current month. Future monthly dues are charged on the first of each month. If membership is not accepted, no charges will be due or paid.