Long Island Women's Agenda, The Voice for Long Island Women

Benefits

Not-for-Profit Members

Corporate & Small Business

Join LIWA

Membership

Join LIWA

Organization Membership Application Form

< back

Membership Classifications

Not for Profit Member:

Not for profit organization with more than 5 employees
Dues - $150.00 per year

Small Not for Profit Member:

Not for profit organization with 5 employees or less
Dues - $100.00 per year

Corporate Member:

For profit businesses with more than 5 employees
Dues - $500.00 per year

Small Business Member:

For profit businesses with 5 employees or less
Dues - $250.00 per year

Annual Dues per Entity

LIWA's membership year is from July 1st to June 30th.
Please check the appropriate membership category:

Not for Profit Organization		$150.00
Small Not for Profit Organization		$100.00
Corporate		$500.00
Small Business		$250.00
Tax Deductible Donation		$
Total		$

* required fields

1. Reference Information

* Representative's Name:

Title:

* Address:

* City:

* State:

* Zip:

* Telephone:

Fax:

* Email Address:

* Does this information pertain to your:
Business
Organization
Home

Company/Organization Name:

Address (if different from above):

City:

State:

Zip:

President/Chair (if not listed above):

Expiration Date of Term in Office (if applicable):

Number of Members/Employees:

Website Address:

Mission Statement (50 words or less):

2. Contact Information

(For organizations and associate organizations only.)

Please supply the following for the person who will:

A. supply your organization's information for inclusion on LIWA's website/newsletter.

Name:

Phone:

Email:

B. receive LIWA materials (newsletter, invitations, press releases, etc.).

Name:

Phone:

Email:

3. Committee Selection

Which committee(s) would you like to join?
Business & Economic Development
Communications
Development
Emerging Leaders
Health
Leadership Council
Legislative Affairs
Membership
Work & Family

4. Click the button below to continue ...

(read our privacy policy)