Online Payments

Professional Women’s Roundtable Online Membership Application Form

Name:  Today's Date:
Business Name:  Birthday:
Title:
Mailing Address: (Is this the address you would like in the directory?)
City:   State:   Zip:
Bus. Phone:   Cell Phone:   Fax:
Email Address:   Website:
Do you own your own business? Yes No
May we include your information in our printed directory? Yes No
May we include your information in our online directory? Yes No
How did you hear about PWR?
Current Community Involvement:
All membership form information must be completely filled out in order for online payment to be accepted.
PWR Dues are $99.00 annually.
All membership is contingent upon PWR board of directors approval.
The membership fee will be refunded if approval is not accepted.

I have read and agree with the terms for submitting an Application for Membership with The Professional Women's Roundtable online, and authorize my application to be processed, including Membership Dues, with the use of my electronic signature.

I have read and agree to the PWR Code of Ethics.

By clicking on "Submit" below, your Membership Application will be forwarded to our Board of Directors for review and you will be redirected to the Membership Dues Payments page. Membership Dues are $99.00 annually, and payment is due with Membership Application. The membership fee will be refunded if approval is not accepted.

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