Membership Benefits

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If you own more than one business, please complete this form as the owner of your most significant firm.

First Name *
Middle Initial
Last Name *
Company Name
Mailing Address
Mailing Address 2
City
State
Zip + 4
Phone
Fax
Email *
Please write a short description of your business. Do NOT exceed 120 characters including punctuation and space.

Percentage of Business Owned
Years In Business
Do you do business internationally?	Yes No
Are you a partner?	Yes No
Number of Employees
Ethnicity (optional)
This fiscal year estimated gross revenue:

What do you hope to gain from your membership?

How did you hear about NAWBO?

Government agencies or corporations with which you are a
certified woman business enterprise:

Membership Categories and Dues Structure
Established Business Owner -Owns an equity interest and actively participates in a business as a sole proprietor, an active partner of a partnership or active member of a limited liability company, an independent contractor, or a 5% or greater shareholder in a corporation	$350
Supporting Member - A non-business owner who subscribes to the objectives of NAWBO and wish to lend support to NAWBO through membership	$500
Emerging Member - A first time business owner with a new business less than two (2) years old, or who has not yet started her business. Reduced rate only available for first year of membership.	$250
Student Member - An individual who is registered full time at a school or university who subscribes to the objectives of NAWBO and intends to start a business	$150

Method of Payment
	Online via credit card
	A Check is In the Mail
	Please Bill Me"
Mail Check to: National Association of Women Business Owners, Chicago Area Chapter 216 W. Jackson Blvd, Suite 625 Chicago, IL 60606

Pursuant to the Revenue Act of 1987, we are required to advise you that your association dues are not deductible as charitable contributions for Federal Income Tax purposes. Your dues payments, however, remain deductible as business expenses to the same extent as permitted under law.

I hereby certify that the information contained in this application is true and complete to the best of my knowledge and belief.