BWN Category You
Wish to Fill: _____________________________2007/2008 MEMBERSHIP APPLICATION
Name: ________________________________________ Date: ______________
Business Name: ____________________________________________________
Title: __________________ Business Address: ___________________________
_________________________________________________________________
Business Telephone: ___________ Fax: ___________ E-Mail: _______________
BWN Category You
Wish to Fill: _____________________________
(NOTE: Please select from the BWN Category List on our website)
Additional categories may or may not be accepted.
Length of Time in this Business: ____________ Home Telephone: ___________
Describe your business: _____________________________________________________
How can you contribute to BWN?_______________________________________________________
____________________________________________________________________________________
How do you see BWN helping your business? _______________________________________________
___________________________________________________________________________________
___________________________________________________________
For the benefit of all members, it is essential that members attend EACH meeting. Will YOU abide by this membership requirement? ___________________________________
I have read and understand the qualifications for membership, and I accept the responsibilities of membership as outlined in the BWN Membership Profile.
Applicant's Signature ______________________________________
Signature ________________________________ Signature ________________________________
Active Member Active Member
Please submit this application with a check made payable to BWN for $100.00 (new member fee).