Women's Leadership Council Membership Registration

How many people are you registering? *

Registration

First Name *

Last Name *

Email Address *

Phone

Please enter the names for Emerging Leader Member Participant

Please enter the names for Guest Participant

Please enter the name of the couples participating

Annual Membership Dues *

Individual Membership - $ 150.00

Business Membership (Up to 4 Members) - $ 500.00

Leader in Transition Membershiop - $ 50.00

Total for this participant

50/50 Raffle

Membership Registration and Renewal

Cell Phone *

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United Way of Lake County