Membership Signup Form

To become a member, complete this form, press the "Submit Listing" button and make your membership payment in one of three ways:

*Option 1*	*Option 2*	*Option 3*
Pay by credit card by visiting the SVBWN Store. (It's easy! Simply follow the directions upon completion of the form below.)	Mail a check to SVBWN P.O. Box 6731 Salinas, CA 93912	Bring a check to our next meeting! Make it payable to "SVBWN".

If you choose payment options 2 or 3, you do not need to do anything further after you click the "Submit Listing" button at the bottom of the application.
For online credit card payment, follow the instructions given after you click "Submit Listing".

Type the information below as you wish it to appear in the SVBWN Directory.

YOUR LOGIN INFORMATION
Email Address:
Password: Choose your own!
Confirm Password:
YOUR NAME & JOB TITLE
First Name:
Middle Name:
Last Name:
Suffix:
Job Title:
BUSINESS MAILING ADDRESS
Company Name:
Address 1:
Address 2:
City:
State:
Zip:
PHYSICAL ADDRESS (IF DIFFERENT TO MAILING ADDRESS)
Address 1:
Address 2:
City:
State:
Zip:
INFORMATION ABOUT YOUR BUSINESS
Category:
Phone 1:
Phone 2:
Fax:
Website:
Description:	(Maximum characters: 250) You have characters left.
How did you hear about us?
	Email me when the site is updated Allow me to receive emails from other members

Salinas Valley Business Women's Network
P.O. Box 6731, Salinas CA 93912.