2018 Membership Application

Please fill out the below information to complete your registration as a member of Women in Business and Regional Development.

Member Details

Name:*
Position:
Company Name:
Industry:
Address:*
E-mail:*
Office / Home Phone:
-
Mobile Phone:*
Website / Facebook address:

The above information provided is subject to the WIBRD Privacy Policy

If you do not wish for your business information to be posted online, please tick the box below.

Post Details online:

Membership Details

Membership Type:*
Membership Category:*

Please include the name and email address of the three staff members to be named on the corporate membership

1st Name:
1st E-mail:
2nd Name:
2nd E-mail:
3rd Name:
3rd E-mail:

Payment Details

Payment Type:*

Please note that Credit Card payments will incur a sticky tickets processing fee.

Upon submission of this form, you will be taken to a page which will contain our bank details for direct transfer and a link to make payment via sticky tickets. A receipt will be emailed upon payment.

Alternatively an email will be sent to you containing a tax invoice for payment via bank transfer.

Declaration

Declaration:*

To join us TODAY simply download this WIBRD Membership Form and email or send it back to us.