Membership Application Form

Please Fill Out Our Application Form

I hereby apply for (please select):*

New Membership

Membership Renewal

If applying as a new member, how did you hear about BPW Greater Moncton?*

First Name*

Last Name*

Home Address*

City*

Province*

Postal Code*

Home Phone

Cell Phone

Email Address*

Please select which ones apply to you*

Business

Employer

School

Job Title

Address

City

Province

Postal Code

*Student applications will not be accepted without the name and address of the institution.

Have you previously been a member of BPW?*

Yes

If Yes, when and where?

Type of membership requested (select one)

ACTIVE MEMBER

ASSOCIATE MEMBER

STUDENT MEMBER

HONORARY MEMBER

Active Member - A woman who, at time of admittance to the Club, is engaged in remunerative employment.
Associate Member - A woman who, at the time of admittance to the Club is not engaged in remunerative employment.
Student member - A woman enrolled in 60% full time or more study at a post-secondary educational institution.
Honorary Member - A woman of special merit, voted an Honorary Member by the Club (includes Lifetime Members).

If you selected "Active Member" please select one of the following

I am a YOUNG BPW (35 and under)

I am 65 years of age or older

What is your date of birth? (year/month/day)

I consent to sharing my name, workplace and photographs taken at Club meetings and events for Club promotional purposes on social media including, but not limited to BPW website and Facebook*

Yes

I consent to being added to the email distribution list of the Club*

Yes

Membership Fees (Select the one that applys to you)*

Active or Associate Member: $125.00

Senior Member: $90.00

Student Member: $90.00

Hororary or Lifetime Member: No Charge

Payment Options*

Download Application Form and Mail in Fee

PayPal

Download Application Form Here

If paying by PayPal: 1) fill out and submit this form. 2.) click on the PayPal button located at the bottom of this page.

I have read and agree to the Code of Conduct*

Yes

To prevent spam please type the characters*

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Click on the Subscribe button.

Please make cheque payable to BPW Greater Moncton,
and mail application form and payment to:

BPW Greater Moncton
RPO North End, Box 29162
Moncton, NB E1G 4R3