Membership Interest Form & New Chapter Registration

IF YOU WANT TO KNOW MORE OR ARE READY TO JOIN DFW:

Are you interested in making a difference in the world through our global 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. Email addresses are used for tax receipts and member newsletters. Thank you for your interest.

Welcome to Dining for Women! To start receiving the DFW newsletters, please click here.

FOR CHAPTER LEADERS ONLY: If you are interested in becoming a chapter leader, in addition to completely filling out this form, please read and agree to the Statement of Mutual Commitment.

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 would prefer to join a Virtual Chapter that meets online, or I would be interested in finding out more about the Virtual Chapter if there are no local chapters in my area.:

Yes

Where did you hear about Dining for Women?:

Radio or TV

Internet

Magazine or newspaper

Other non-profit organization

Friend

Half the Sky Movement

Oprah Magazine

People Magazine

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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