East Bay Women's Network - Membership Application

Membership Application

Yearly membership fees are only $90. To join complete this form then click on the "Submit" button or contact Vicki Powers, Membership Chair at (510) 381-0301 or . Please bring your membership dues to our next meeting, the first Wednesday of each month.

East Bay Women's Network Membership Application:

First Name*
Last Name*
Business Name*
Business Address*
City, State, Zip*
Phone*
Fax (leave blank if none)
Birthday* (month/day)
Occupation*
Type of Business*
What category would your business fall under?*
E-mail*
Web site
How did you hear about EBWN?*
What would you like to get out of EBWN?*
I plan to attend the next meeting?*
	Highlight this text and tell us more about you and your business
* (required information)