Join the Women Business Owners Network of the Triangle today!
Your Name
Date of Birth
Cell Phone
Office Phone
Home Address
City
State
Zip Code
Email Address
Business Name
Occupation
Are you the owner? yesno
Business Address
Zip
Association 1 Position How many years Are you a board member?yesno Are you a sponsor? yesno
Association 2 Position How many years Are you a board member?yesno Are you a sponsor? yesno
Association 3 Position How many years Are you a board member?yesno Are you a sponsor? yesno
Membership Level Requested: Platinum $750Gold $500Silver $300Corporate $200Individual $99 Lunch Sponsor (Member-$100) (Non-Member $200) yesno
Are you interested in being a guest speaker yesno Speaker topic
Signature (type your name as digital signature) Today's Date
Please email 1 business reference and 1 personal reference to Jodi at Jodih@platinumbusinessnc.com.
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