MEMBERSHIP FORM What is your name? * First Name Last Name Email * Phone (###) ### #### Membership Package * Which membership package are you interested in? Community Diamond What is your job title or role? * Which one of these applies to you? * I want to develop my skills, focus on learning and network with like-minded women. I have a pretty busy schedule so at this moment I can onlv commit to promoting and receiving BSGN updates. Iam only looking to support and provide mentorship I'm interested in corporate membership and sponsorship Tell us about yourself in a short bio * what are your goals? where do you see yourself? List any accomplishments. What is your current employment position/status? EMPLOYED SELF EMPLOYED DIRECTOR STUDENT OTHER WHICH SERVICES ARE YOU MOST INTERESTED IN? * SELECT AS MANY THAT APPLIES NETWORKING FUNDING MENTORSHIP RETREATS How did you hear about us? SOCIAL MEDIA SEARCH ENGINE (GOOGLE ETC) WORD OF MOUTH RADIO/PODCAST NETWORKING EVENT EVENTBRITE Thank you!