Membership Interest Form & New Chapter Registration

FOR THOSE WANTING TO KNOW MORE, OR WHO ARE READY TO JOIN DFW:

Are you interested in making a difference in the world through our innovative giving circle? Please complete the form below and check all the areas of interest that apply to you. We will contact you right away!

Your contact information will be kept confidential and not shared with any other organization. Thank you for your interest.

WANT TO TAKE THE NEXT STEP AND CREATE A CHAPTER?

There are three additional steps to register your chapter:
1. Fill this form out completely, including the questions specific to new chapters near the bottom of the form.

2. Please also read the Statement of Mutual Commitment. (You will be indicating your agreement with the statement in this form.)

3. Pay the $25 application processing fee, either through Paypal (using a Paypal account or simply a credit card online) or by sending a check to: Dining for Women, PO Box 25633, Greenville, SC 29616

That's it!!! Welcome to Dining for Women!

First Name: *

Last Name: *

Email Address: *

Phone (area code first): *

Street Address (mandatory for Chapter Leader applications):

City: *

State: *

Country:

Zipcode:

I am interested in finding out about joining a Chapter in my area:

Yes

I am interested in joining a Virtual Chapter that meets online:

Yes

Where did you hear about Dining for Women?:

Radio or TV

Internet

Magazine or newspaper

Other non-profit organization

Friend

None of those: I heard about Dining for Women through:

Other comments/questions:

I am interested in starting a Chapter (Please answer ALL questions below if you plan to start a Chapter!):

Yes

Nearby intersection or major street for placing chapter on the Find a Chapter map (to preserve the privacy of Leader's home):

If you have a co-leader, please enter her contact information:

When do you plan to hold your first meeting?:

I have read and agree to abide by the Statement of Mutual Commitment as a new Chapter Leader:

Yes

No

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