Membership Application

Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Phone *

(###)

###

####

Skills *

Check all that apply

Public Relations

Web Design

Writing/Editing

Grant Writing

Public Speaking

Auditing

Legal

Health Provider

Event Planning

Mentoring

Graphic Design

Leadership Development

Other

Committee Interest *

Fund Development

Public Policy

Building Bridges to Success

Communications

Health

Education

Economic Empowerment

Bylaws and Procedures

Application Acknowledgement *

Please note that once you click the "submit" button you will be redirected to a separate page where you will be asked to submit additional required documents for membership consideration. By checking this box, you hereby acknowledge that failure to complete the application in its entirety will result in your application being terminated and/or points being deducted from your overall score. Furthermore, if granted membership into the organization you acknowledge that the time commitment will extend beyond the monthly chapter meetings.

I Accept