SSWBN Membership Application

Please complete this application form and submit. If you prefer to use a paper application, click here to download.

Name
Title
Company Name
Address
City, State, Zip
Work Phone
Home Phone
Fax
Email
Website URL:
How Did You Hear About SSWBN?
Membership Directory Category
Brief Business Description (180 characters or less including spaces and punctuation):
Use your own credit card with our Paypal shopping cart. Click on the "Submit" button to be directed to the PayPal order page to complete your application.

Membership Fees:

Individual Membership - $235.00 for 12-months. Note: Additional individual memberships from same company are discounted. Please contact us for rates. Please duplicate this form for additional members from the same company.

Corporate Membership - $1,000 for 12-months, Note: This membership includes multiple directory listings and unlimited event attendance at the member rates.

Want to pay by check?
Make check payable & mail with form to:

South Shore Women’s Business Network, P. O. Box577, Accord, MA 02018-0577. Your cancelled check is your receipt.