Please refer to the "Are You Eligible" page. By submitting this Application you certify that you meet one or more of the Eligibility Guidelines and if called upon, can furnish proof of eligibility.
Print this form out and mail it to PO Box 412, Masonville CO 80541 or fax it to 970-669-7929
Colorado Women of Influence™ LLC
Application for Membership
Date of Application:
Name:
Company:
Title:
Phone:
Fax:
Mailing Address:
Email:
I, ________________(the applicant), have been nominated for membership by the current active Member, _________________. I hereby certify that I meet the eligibility guidelines and I am eligible for Membership. I understand this application will be reviewed by the Advisory Committee before I am selected to become a member.
Women of Influence Member: Cost: $250. An individual membership for a woman who meets the criteria for membership, as noted in the "are you eligible" guidelines on www.coloradowomenofinfluence.com .
Note: Membership in Colorado Women of Influence LLC is on a yearly basis, and must be renewed by the anniversary of your joining. Membership in Colorado Women of Influence LCC stays with the individual, not the company, and cannot be transferred. Your membership payment is non-refundable. Your membership payment is not deductible as a charitable donation.
Please check your eligibility category:
❑ An business owner with an established e-commerce website, shop, building or other physical presence, open to the public, who exercises the power to make policy decisions and is actively involved in the day-to-day management of the firm.
❑ A sole proprietor, consumer-direct or direct-sales business owner who has achieved executive status and is recognized as a top producer & leader in her company because of exceptional sales and leadership responsibilities, whose agenda is to build a sustainable, relationship-driven business.
❑ A corporate executive who is the senior operating manager (President or VP) or chief decision maker for her company or non-profit organization, or a former chief decision maker.
❑ An entrepreneur whose company has annual gross revenues in excess of $100,000, who is running the company-day-to-day, who founded the company and /or her current ownership interest provides active control over the company.
❑ An educator, associated with a higher learning institution.
❑ An elected official.
❑ A “leader in the community.”
Why do you want to become a member of Colorado Women of Influence?
What do you hope to contribute to the organization?
Please list one business and one person reference.
Applicant Signature: _____________________________
Date: ________________________
Payment Information
Check #_________ in the amount of $____________.
CREDIT CARD INFORMATION
Circle: Visa, Mastercard, American Express, Discover, Diners Club, or bank debit card
Credit card #
Expiration date:
Name on card:
CVC number:
Billing address:
Billins zip:
I authorize Colorado Women of Influence to charge my credit card $________ for my membership ☐
Signature:
Mail or fax to Colorado Women of Influence
PO Box 412, Masonville CO 80541
970-669-5089 Fax 970-669-7929
Form Memb Rev November 22, 2009