American Business Women’s Association Membership Application Please submit this application to our national team. We look forward to welcoming you to ABWA! ABWA National Headquarters 9100 Ward Parkway | PO Box 8728 | Kansas City, MO 64114 P: 800-228-0007 | F: 816-361-4991 | E: email@example.com New Member Contact InformationFirst Name: _____________________________ M.I.: ________ Last Name: ____________________________________Primary Mailing Address: ______________________________________________________________________________Primary Phone: _______________________________________ Fax: _________________________________________E-Mail Address: _____________________________________________________________________________________Please note: Your e-mail address is required to access your membership and conduct business at www.abwa.org. By providing your e-mail address, you authorize ABWA to contact you by e-mail. Demographic Information (for statistical purposes only)Birthday (MM/DD): ________ / ________ Birth Year: ________ Gender: Female MaleEducation Completed: _________________________________________ I am a business owner.Job Title: _______________________________ Industry: ___________________________________________________Company Name: ______________________________________ Website: ______________________________________Business Address: ___________________________________________________________________________________Products/Services: ___________________________________________________________________________________ Affiliation InformationI learned about ABWA via: ______________________________ Sponsor’s Name: _______________________________I am interested in: Joining a local Chapter/Express Network in my area. Please contact me with information. Joining this Chapter/Express Network: ____________________________________________ Starting a new Chapter/Express Network. Please contact me about this opportunity. National Membership InformationABWA Membership Type: Express Network ($100 Dues + $15 WIN Tech Fee) $115 Basic ($75 Dues + $15 WIN Tech Fee) $ 90 Special Discounted Membership Options* Express Network Student ($50 Dues + $15 WIN Tech Fee)* $ 65 Basic Retired ($40 Dues + $15 WIN Tech Fee)* $ 55 Basic Student ($35 Dues + $15 WIN Tech Fee)* $ 50Additional Opportunities: Company Connection Premier Subscription $100 Company Connection Essential Subscription $ 75 Additional Postage & Processing for International Members $ 25 Total ABWA National Membership Payment Due: $____Note: Membership in ABWA Chapters/Express Networks is contingent upon payment of national dues. Additional local dues may apply. *Discounts require supporting information. Call ABWA to apply. Payment Information Please find my check for $ _____ included with this form. Please charge $ _____ to the following credit card:Card Type: __________ Credit Card #: _______ / _______ / _______ / _______ Exp. Date: ______ CVV Code: ______Name on Card: _______________________________________ Signature: _____________________________________Note: ABWA gladly accepts Visa, MasterCard, and Discover credit cards; we do not accept American Express (AMEX). Dues InformationBenefits of membership begin the date your application and payment are received and processed at ABWA National. Your anniversary date is the first day of the monthfollowing the date your application is processed and renews annually. Membership in ABWA is individual. DUES ARE NON-TRANSFERRABLE AND NON-REFUNDABLE.The American Business Women’s Association is a non-profit organization serviced by ABWA Management, LLC, a company organized for profit. All ABWA income is received by ABWA Management, LLC,and in exchange the company provides all necessary services and materials to the ABWA membership. The Company Connection™ is a registered trademark of ABWA Management, LLC, providingservices to business owners. Dues are not deductible as a charitable contribution for federal income tax purposes; however, they may be deductible business expenses under provisions of IRS codes.