Membership Application

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Membership:

1 Year Membership

2 Year Membership

Student Membership

Gift

The membership you have selected will automatically renew.

Your Information

First Name: Last Name: Company: Title:

Contact Information

Email: Phone: Home Address: City: State: Zip Code: - Country:

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Social Media

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Member Demographics

How did you hear about WIT? What inspired you to join WIT?

Friend or Colleague Recommended

Attended at a chapter event

Attended a WIT trade show event

Learned about WIT on LinkedIn

Learned about WIT on Facebook

Learned about WIT in trade media

Name of person who referred you? Are you interested in joining YPN? ( WIT Young Professionals Network)

Yes

Where are you in your career? What field(s) do you work in? Corporate or Independent? My Business (briefly explain your business) Areas of expertise? (list keywords) Seniority Level Age Bracket

18-24 years old

25-34 years old

35-44 years old

45-54 years old

55-64 years old

65-74 years old

75 years or older

Gender Chapter

Additional Donation:

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