WOMEN UNITED MEMBERSHIP REGISTRATION AND RENEWAL FORM

Contribution Amount *

Individual Membership - $ 150.00

Business Membership (up to 4 Members) - $ 500.00

Retired/Leader in Transition/Student - $ 50.00

Total Amount

Women United Registration Form

First Name *

Last Name *

Email *

Employer *

Job Title *

Cell Phone *

Work Phone

Would you like to be included in the Women United directory? *

Yes No

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United Way of Lake County