Queen City Revival Membership Form

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Queen City Revival Membership Form

Thank you for your interest in joining Queen City Revival! Our mission is cultivating opportunities for young professionals to make an impact in WNY. Please complete the form below to become a member.

As a member, you will enjoy exclusive perks that support your personal and professional growth while connecting you with other young professionals.

Membership benefits include:

Stay Informed: Receive updates on events, programs, and initiatives through our email list.

Exclusive Discounts: Get special pricing on event tickets and exclusive deals on Queen City Revival apparel.

Skill Development: Through volunteering, you will gain exposure to opportunities to develop your skills.

Networking Opportunities: Build meaningful connections with peers and community leaders.

Full Name: (First, Last)

Our Membership Directory is a resource designed to help members connect with one another beyond our volunteer and fundraising events. The directory includes your name, industry, LinkedIn URL, and photo. Would you like to be listed? *

Yes

Preferred Name/Nickname (Optional)

Email Address

Phone Number

Home Address (Street, City, State, Zip Code)

Date of Birth (MM/DD/YYYY)

Current Occupation (Job Title)

Employer (Company Name)

LinkedIn Profile (Optional) *

Why are you interested in joining Queen City Revival?

Which areas of our work are you most interested in?
(Check all that apply) *

Event Planning and Fundraising

Community Outreach

Marketing and Social Media

Volunteer Coordination

Administrative Support

Other:

Required

What skills or expertise can you contribute to our organization?

Are you willing to volunteer at Queen City Revival events?

Yes

Maybe, please contact me with more information

Required

Queen City Revival is a nonprofit organization, and we rely on member support. Member dues are $30.00 annually. Membership includes special discounts on apparel and event tickets, email updates for upcoming events, networking opportunities, and an invitation to our annual meeting to contribute your ideas to our organization. *

I would like to contribute $30.00 to receive membership benefits for one year. Membership dues can be paid by cash or check. If you select yes, you will receive a separate communication with instructions.

I already paid my dues at a recent QCR event

Required

How would you prefer to receive updates and communications from Queen City Revival?
(Select all that apply) *

Text Message

Phone Call

Social Media

Required

How did you hear about Queen City Revival?

Friend or Family

Social Media

Event

Website

Other:

Required

Do you have any questions or suggestions for us?

Thank you for your interest in Queen City Revival! We will be in touch soon with more information about upcoming events and volunteer opportunities!

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