QWB+A Local Chapter Leader Form
Dear Chapter Leader,

In order for us to support you and your chapter, we'd like know a few things about you. We value your commitment to the QWB+A cause and look forward to hearing about your chapter journey!

Kindly complete this form before you start your journey with us.

Welcome to the team!
QWB+A Team

Please email info@qwballies.coom if you have any questions.
Email address *
Email Address *
Your answer
First Name *
Your answer
Last Name *
Your answer
City *
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Country *
Your answer
Industry *
Your answer
Company *
Your answer
Role *
Your answer
I am currently... *
How did you hear about QWB+A? *
Your answer
Why do you want to be a QWB+A Local Chapter Leader? *
Your answer
Would you like to co-lead your chapter with someone? If so, please add their email address and Linkedin/ Facebook/ Instagram link if applicable. *
Your answer
Have you attended a QWB+A event before? (you do not need to have attended our events before to be a chapter leader, we will coach you through the process.) *
Would you be able to connect over a call with other chapter leaders once a month? *
Your answer
Please list a few ideas that you have for the chapter you want to run (nothing too serious nor set in stone, we just want to hear your thoughts about what you think your local QWB+A's would like to experience and how it relates to our brand. Feel free to mention some gaps that you have seen in your community). *
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Contact Number *
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Linkedin Link (If you do not have, please type "N/A") *
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Facebook Link (If you do not have, please type "N/A") *
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Twitter Link (If you do not have, please type "N/A") *
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Instagram Link (If you do not have, please type "N/A") *
Your answer
What are you most excited about in leading a chapter? *
Your answer
What challenges have you faced as a queer woman, trans identifying, non-binary or ally relating to queer women in business and the workplace? *
Your answer
What questions do you have for us? *
Your answer
What pronoun do you prefer to be addressed by? *
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How do you identify (Select all that apply. please understand that this information is private and confidential and will not be publicly shared without permission. This is for record keeping and ensuring that we are diverse in our chapter leader team.) *
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