Membership Form

CLICK HERE to fill out the online membership form

or print and fill out the form below:

Thank you so much for your interest in joining WENA! The information you provide is for planning purposes for the meetings, for information to give to the organizations that receive our donations and for a directory.

Together we are making an impact through these one-hour meetings, three times a year, with a donation of $100 each meeting.

I hope you’ll join us in making a difference in the lives of others.

—Thank you! Katie and Susan

womenempoweringnaz@gmail.com

928-380-5695

(Please Print) Name____________________________________________________

Street Address________________________________________________________

City, State & Zip_______________________________________________________

Telephone___________________________________________________________

Email______________________________________________________________

Commitment: I understand if I choose to become a member of WENA I am making a personal commitment to donate $300.00 each year, $100.00 each meeting, to non-profits serving Northern Arizona. This commitment continues 3/year until I let WENA know that I can no longer be an active member.

I also understand that, even if the charity chosen is not my first choice, as a member I will donate to the charity of the group’s choice. If I am not able to attend the meeting it is my responsibility to make every effort to have the check in by the time of the meeting. By filling out the form below you are committing the above.

I understand this is an HONOR agreement, not a legal agreement. My commitment will automatically renew, for successive one (1) year periods, unless notice is given. I understand I may withdraw at any time.

__________________________________________________________________

Your Signature Date

Please feel free to print this out or to copy, paste and email this form back to us.

Thanks for your support and being willing to join us in making an impact!