Membership Application

Name:

Professional & civic affiliations and accomplishments:

Please give a brief description of your work:

Member Birthday:

LinkedIn Name:

Twitter Handle:

FaceBook Name:

Zip:

State:

City:

Address 1:

Address 2:

Company:

Email:

Alternate Phone:

Cell Phone:

Spouse / Partner's Name:

Work Title:

What area of expertise are you interested for helping WEC fulfill its mission? (choose one, any additional interest add in the comment section):

Personal interests you would like to share such as family, hobbies, etc.: