Apply to Join a Chapter

Please select a chapter below
* indicates required
WIN Chapter:
First Name*:
Last Name*:
Business Name*:
Business Category*:
New Business Category
if none above apply:

It cannot be one of these:
Address*
City*
State*
Zip*
Business Phone*:
(nnn) nnn-nnnn ext nnn
Cell Phone:
(nnn) nnn-nnnn ext nnn
Your Email*
Website:

Include samples/information about any of the following: pricelist, marketing materials, website, any professional or service groups and any other networking groups which you are a member of (no religious or political groups, please). You may upload one file (MsWord or an image or small movie or a pdf ) using the browse button or simply tell us in words where to find your samples/information.

Is this your primary business?*YesNo

Please list any other businesses in which you are involved:

Tell us a little about yourself, your business, and why you are interested in joining WIN*

Have you ever applied to/been a member of WIN previously?* YesNo

How did you hear about us?

Fees:

  • One time application fee of $25.00 and annual membership fee of $115.00 will be invoiced upon membership approval and can be paid via the link on the invoice.
  • Membership in WIN, Inc. and its benefits are effective upon payment of above invoice and participation in New Member Orientation.

References

Please provide two references outside the current WIN membership, preferably someone who can speak about your business and/or business practices.

Name #1*: Business Name:*
Address:* Phone:*
Cell Phone:
Association with Applicant: *

Name #2*: Business Name:*
Address:* Phone:*
Cell Phone:
Association with Applicant:*

I agree that the information provided above is correct, complete, and current. I understand that membership privileges are not conveyed until application is approved, annual membership fee is paid in full, and New Member Orientation is completed. I will comply with all WIN policies in promoting my primary business category ONLY. Violation of the business category policy and other WIN policies may result in dismissal from WIN. By signing this application, I recognize that pictures will be taken of meetings now and then for the purpose of marketing and promotion. I give my permission to WIN to copy, print, and include on social media any pictures that may include my image.

I accept the above conditions:

Please complete the Captcha below to prove you are a person, and press the SEND button:
captcha

If the Send Button above is not clickable, be sure you checked the box "I accept the above conditions:". After clicking Send, you should immediately get a message that your application has been submitted. If you don't, scroll to the top and look for error messages. Perhaps you forgot a required field.