NACW Lansing Chapter Membership Application 2017-2018
Form must be filled out by all new and renewing NACW members. Business information may be included in the NACW online member directory.
Personal Information
Please provide your personal contact information. This information will not be shared publicly.
First Name
Your answer
Last Name
Your answer
Address (street)
Your answer
Your answer
Your answer
Your answer
Primary Phone
Your answer
Primary email address
Notifications & newsletters will be sent to this email address.
Your answer
Business Information
Please provide any relevant business information to be displayed in the NACW online directory.
Company Name
Your answer
Company address or physical location.
Your answer
Company phone
Your answer
Your title
Your answer
Type of business or describe services.
Your answer
Business email address
Your answer
Business website
Your answer
Membership year: October 2017 - September 2018.
$150 new member
$100 renewing member

*All memberships include a $25 Lansing Chapter administration fee.

Membership type:
Payment type:
Please select your method of payment.
Thank you!
If you selected to pay online via Paypal, a link will be sent to you once your application is received.

To pay by check, send payment to:
NACW Lansing Chapter
P.O. Box 27203
Lansing, MI 48909-7203

Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms