WINApplication - Women's International Network (WIN)

MEMBERSHIP APPLICATION

POTENTIAL MEMBER INFORMATION:

Name of Organization: ________________________________________________

Your Name: _________________________________________________________

Your Title: __________________________________________________________

Address: ___________________________________________________________

City/State/Zip:_______________________________________________________

Phone: ______________________ Alternate Phone: ______________________

Fax:_________________________ Work Phone: _________________________

Email Address: _____________________________________________________

Website Address: ___________________________________________________

Type of Organization: ______ Profit ______ Non-Profit

Describe your organization and products/services you provide.

__________________________________________________________________

Years in Organization: ______________ Are you incorporated? Y/N

State Inc.: _____________

REFERENCES: (Please provide at least two references)

Name: ____________________________________________________________

Title/Organization: __________________________________________________

Telephone No: ___________________________

Name: ____________________________________________________________

Title/Organization: __________________________________________________

Telephone No: ___________________________

PLEASE READ THE FOLLOWING:

I, ______________________________________, understand that my references listed on this application may be verified by the Women’s International Network (aka WIN) organization to ensure my character is of sound and excellent reputation. I understand that WIN does not provide any type of accountability or covering and can in no way attest to the soundness of my organization. I understand that WIN is an organization established solely for the purpose of networking resources with other WIN members in a concentrated platform.

I understand that my contact and association with any of the WIN members is strictly voluntary. The WIN organization is not responsible for any non-contractual, verbal, or contractual agreements entered between WIN members. I perpetually release the WIN organization from damages, claims, or liabilities for such relationships. It is highly recommended by WIN board members and president/founder to contact legal representative before entering into any type of agreements with WIN members.

WIN is not responsible for claims about products and services of any WIN members verbal or non-verbal including written pamphlets, websites, brochures, and any other materials stating claims about WIN members products and services. I perpetually release the WIN organization from damages, claims or liabilities resulting from claims concerning WIN members products and services.

I will provide financial support to defray the WIN budget as often as I can. With this application, I have included $______ and understand that financial support is not mandatory.

Signature of Applicant: ___________________________ Date: __________________

Print Name: ________________________________________________________

Please save application as a Microsoft Word or .PDF file and email to: womensintlnetwork@hotmail.com. You can also print and mail to: WIN, P.O. Box 941874, Plano, TX 75094.

You will be notified within two weeks of submittal if your application has been accepted.

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BELOW FOR OFFICE USE ONLY:

Staff Reviewer Name: ________________________________________________

Review Date: ________________

Application Accepted: _______ Application Denied: _______

References Verified: Y/N By Whom:_____________________________________

Further Review Recommended: Y/N

Comments: ________________________________________________________

__________________________________________________________________

Amount Offering: $ ________________ Method: ________________