Application Process

We encourage you to join our dynamic organization. In order to expedite your membership, please complete the application form below or download, complete and mail the Application ( PDF, 20kb) to the address below. Please also include a recent picture for the membership roster and a check for annual dues*. For digital photos, .jpg format of at least 200 pixels is preferred. Application materials should be mailed to: Women’s Leadership Network, P.O. Box 1275, Helena, MT 59624.

WLN typically submits a press release to the newspaper’s Sunday business section when you join. If you prefer we don’t submit a press release, please check the appropriate “No” box on the application. We incorporate your professional information in our annual membership roster to be distributed to our members in order to facilitate networking. If you have any questions, please don’t hesitate to contact Association Manager, Meg Lewis at 431-1243.

The ability to communicate with you via e-mail and regular mail is paramount to the success of our organization. Please provide the most convenient addresses, so that we are able to distribute information effectively.

Annual membership rosters and postcards announcing upcoming programs are send through the postal service and meeting notices and reservations are sent via e-mail.

Thank you for your interest in Women’s Leadership Network. We look forward to having you join us.

*Annual Dues

Annual dues are prorated based on the month you join

• January-June: $100.00
• July-October: $50.00
• November-December: $100.00 includes full membership in following year

Revised 09/2005

Application Form

Fields marked with an asterisk are required. One address, phone and e-mail address is required. If entering multiple addresses, select the radio buttom next to the your preferred primary contact address.

Name * Occupation/Profession *

Business Information

Business/Employer Name * Department and Title Type of Business

Street Address preferred

Street City State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Code

Mailing Address preferred

Street City State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Code

Phone * Fax Cell E-mail Address preferred *

Personal Information

Street Address preferred

Street City State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Code

Mailing Address preferred

Street City State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Code

Phone Fax Cell E-mail Address preferred *

Press Release Preference *

Indicate your preference below for included in a press release.

• Yes
• No

Additional Information

Please include your title or area of expertise, length of time with present employer, significant accomplishments, personal & professional Affiliations or boards, and any personal details or special interests you would like highlighted.