SWAN - Membership Form

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To become a SWAN member, please fill out the online form below. The email form will be sent to the chapter of your choice for processing. Once your membership payment is confirmed, you will receive an email containing your login and password information where you will be able to access the SWAN membership Directory and other tools exclusive for members.

Information provided on this form will be used to complete the Membership Directory and contact lists.

Please enter information for all required fields. Thank you!

Member Name*:

Referred By:

Membership Type*:

Birthday:

Business Name*:

Prefered Chapter*:

Address*:

City*:

Postal Code:

Telephone*:

Fax:

Cell:

email*:

Website:

Title/Position:

BUSINESS CATEGORY: When selecting your Business Category, please keep in mind this will be used as a service reference in the SWAN Directory.

I would be interested in participating on one of the following committees:

	Treasurer		Events
	Secretary		PR/Communications
	Website		Historian
	Membership		Greeters
	Newsletter		Directory

Please provide us with a small biography about yourself and your business/services. This information will be printed in our Membership Directory. Maximum 50 words.

Would you like your website link placed in the online directory of SWANs website?

I would like to advertise with SWAN. Please send me more info:

PRIVACY ACKNOWLEDGMENT
The information provided by individual members to Successful Women Always Network (SWAN)
including name, address, contact information and biography/resume - is collected for the purpose of distribution to all members of SWAN wherever any chapter of SWAN may exist, both in printed form and online on the SWAN website. The information collected by SWAN becomes a matter of public record once it is printed in the member directory or published on the website and SWAN cannot guarantee that the information will not be distributed beyond the control of SWAN.
I hereby acknowledge that the information provided by me may be published in the printed Member Directory and on the SWAN website and I further acknowledge that I may be contacted in the future by persons having access to the printed Member Directory and SWAN's website.
I further stipulate that any photographs taken at or during SWAN events in which I or any members of my company may appear may be published on the SWAN website at the discretion of the Executive of my chapter of SWAN without my express and specific approval of any particular photograph and with no expectation of remuneration.

*I hereby agree to the above privacy agreement: