Date: ________________________________
Name: _________________________________________________________________
Title: _________________________________________________________________
Business Name:
_________________________________________________________________
Business
Street Address: _________________________________________________________________
City,
State, Zip: _________________________________________________________________
Business
Phone: _________________________________________________________________
Business
Fax: _________________________________________________________________
Email: _________________________________________________________________
Website: _________________________________________________________________
Home
Street Address: _________________________________________________________________
City,
State, Zip: _________________________________________________________________
Home
Phone: _________________________________________________________________
Cell
phone: _________________________________________________________________
Membership
Options*
o WPO Chapter (annual fee: $1,650) Chapter:
_____________________
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: $4,500 plus one of the previous memberships)
o My annual revenues exceed $10 million.
o WPO Alumna
Membership (annual fee: $850)
o I was a chapter member for three or more
years.
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
$______________
Method of Payment
o Credit Card o MC
o Visa
o AX
#_________________________________________________________ Exp.
Date______ 3 or 4 digit security code_____
o Check (Please make payable to Women
Presidents’ Organization, Inc.
Membership must be paid in US dollars.)
*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 CPA may 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 20-29
o 30-39
o 40-49
o 50-59 o over 60
Education: o High School o BA/BS o
JD
o MA
o PhD
Marital Status: o single
o married o divorced o widowed o domestic partner
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
Revised:
June 2010
WPO Member
Confidentiality Agreement
Due to the sensitive nature of information
discussed in the meetings of the Women Presidents’ Organization (WPO), to
protect the privacy, both personal and professional, of all in attendance, I,
the undersigned, agree not to divulge any non-public information learned during
WPO meetings to any third party and to treat said information with discretion
and respect.
WPO Member Code of
Conduct Pledge
The Women Presidents' Organization (WPO) is
committed to ethical practices. Each of our members sets an example for her
peers by her pursuit of business achievement with honesty and integrity. These
values are vital to the professional standing of the WPO and its members. To
that end, we have adopted the following Code of Conduct Pledge, to inspire
ethical behavior on behalf of all members:
WPO Member Code of Conduct Pledge
I pledge:
To conduct my business and business relationships with
honesty and integrity; to avoid deceptive business practices; and to obey laws
and public policies governing my business.
I understand and accept that executing this Code of
Conduct Pledge is a condition of membership in the WPO, and renewal of membership,
and my failure to comport with this Pledge may result in the denial of a
membership application or membership renewal application to the WPO, or
revocation or suspension of my WPO membership.
__________________________________________
Signature
__________________________________________
Print Name
__________________________________________
Name of Company
__________________________________________
Chapter
__________________________________________
Date