Date: ________________________________
Name: _________________________________________________________________
Title: _________________________________________________________________
Business Name:
_________________________________________________________________
Business Street Address: _________________________________________________________________
City, State, Zip: _________________________________________________________________
Business Phone: _________________________________________________________________
Business Fax: _________________________________________________________________
Email: _________________________________________________________________
Home Street Address: _________________________________________________________________
City, State, Zip: _________________________________________________________________
Home Phone: _________________________________________________________________
Cell phone: _________________________________________________________________
Membership
Options*
o WPO Chapter (annual fee: $1,500) City/State:
_____________________
o WPO Membership-at-Large (annual fee: $850)
City/State: _____________________
o My area does not yet have a WPO chapter.
o I prefer not to attend monthly
meetings.
o WPO Platinum
Group
(annual fee: $4,000 plus one of the previous memberships)
o My annual revenues exceed $10 million.
o WPO Help Us
Grow
I am making a donation to
help the WPO grow in the amount of:
o $200 o $350 o $500 Other
$______________
Credit
Card o MC
o Visa
o AX
#_________________________________________________________ Exp. Date_____________
o Check (Please make payable to Women
Presidents' Organization, Inc..)
o Invoice
* Membership fee is nonrefundable. Applicant must be
an owner and/or president, chairman, managing partner of a company that
generates revenues over $1 million (service based) or $2 million (product
based). Verification by a CPA will be required.
Company Statistics
Type of Business: ___________________________
Form
of Business:
o corporation o sole proprietorship o partnership
Number
of Employees: _______________
Annual Gross Revenues: _______________
Date Established: _______________
Age: o 30-39 o 40-49 o 50-59 o over 60
Education:
o High School
o BA/BS o MA o PhD
Marital Status:
o married
o domestic partner o single
o divorced
Children
o yes
o no
Membership
in the WPO requires that the applicant's company prove annual gross revenues
for its most recent preceding fiscal year. For product-based businesses, annual
gross revenues must exceed $2 million. For service-based businesses, annual
gross revenues must exceed $1 million; however, if the company is a commission
business that is dependent on contractual sales, the company must exceed annual
gross contract revenues of $5 million.
The
applicant hereby attests that her company meets one of the aforementioned
membership criteria.
The
applicant understands that the WPO reserves the right to terminate the
membership of any member who provides false or misleading information in
connection with her WPO membership application.
______________________ _________________________________________
Date Signature
of Applicant
or mail to 155 E. 55th,
Ste. 4-H, New York, NY 10022
Revised: April 2006
Dues and contributions to the WPO are not deductible as charitable contributions;
however, they may be deductible as ordinary and necessary business expenses.