Membership Application

Name

First Name

Last Name

Title

Company

Field of Business Expertise

Contact Phone Number

(###)

###

####

Email

Location City

Location State

Sponsor's Name

First Name

Last Name

Sponsor’s Email Address

Other affiliated organizations (profit and not for profit):

Primary Reason for Joining (i.e. network and community, resources, leadership development, mentorship and giving back, etc...)

Disclosure:

Membership is by referral only. Although there are no membership fees, we highlight that as a not for profit organization, our mission and goals are dependent on charitable giving.

Non Solicitation Clause:

We encourage our members to connect and collaborate. However, to ensure a safe space, we have a strict non-solicitation policy and do not allow proactive sales or marketing efforts within the Empower Women That Rock community for the sole purpose of driving future business.

Membership Application

EMPOWER WOMEN THAT ROCK