New Member Info

We are so glad to have you join us at WBOM. Once you have completed the membership application, you will be directed to a page to add the appropriate membership to purchase. Once your membership payment is completed and your form has been received, a member of the board will get in touch with you to verify your membership. We hope you gain much from your membership with WBOM.

First Name (required):

Middle Initial:

Last Name (required):

Company Address


Company Name (required):

Company Address (required):

City (required):

State (required):

Zip (required):

Phone:

Fax:

Mailing Address (Optional)


Mailing Address:

City:

State:

Zip:

Contact Info


Website:

Email (required):

Home Phone:

Other Phone:

Business Info


Business Start Date:

Type of Business (required):

% of Ownership (required):

# of Employees:

Category of Business (required):

Description of Business (required):

About You


Education:

School and Major:

Other Board Positions:

Other Interests:

Birthday (mm/dd/yyyy):

How did you hear about WBOM:

Recommendations/Remarks:

As part of my membership privileges, I volunteer to serve on the following committee(s):
Programs - MeetingsPrograms - EventsMembership - AcquisitionMembership - RetentionNewsletterPublic RelationsDirectoryArchivesFinance

To redeem a gift certificate or to activate a membership that was prepaid, please check here:Manual Payment