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Membership Application
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* Indicates required question
Email
*
Your email
First Name
*
Your answer
Last Name
*
Your answer
Address
*
Your answer
Home Number
*
Your answer
Cell Phone Number
*
Your answer
Birth Date
*
MM
/
DD
/
YYYY
Annual enrollment starts to become due on October 1st.
Annual Dues: (covering January 1st through December 31st)
Please check only one box.
*
$10 for a Replacement Name Badge
$35 to Renew for the Standard Membership only
$45 for New/Standard and (Associate membership for men) Memberships
$50 for Silver Membership - (includes VIP status)
$100 for Gold Membership - (Silver membership level + 1 free lunch)
$500 for Diamond Membership - (Silver membership level + 10 free lunches)
How will you be paying for your membership dues?
*
PayPal with a debit or credit card
By Check. Mailed to WCRW PO Box 910722, St. George, Utah 84791, check made out to WCRW
Who referred you to WCRW?
* If no one referred you, please put N/A.
*
Your answer
Refer a friend: Who do you know that might be interested in WCRW?
Please provide Name, & Phone Number (we'll call them)
Your answer
A copy of your responses will be emailed to the address you provided.
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