Thank you for your interest in becoming a WomanACT member. As a WomanACT member, you are committed to further WomanACT’s Vision, Mission, and Values Statements. The following questions will help us assess your membership request. The information collected will remain confidential.

1. How did you originally learn about WomanACT

2. Tell us about your interest in joining WomanACT Membership:

3. Tell us about your current or past experiences that could be interpreted as supportive of our Mission, Vision or Values. Please provide specific examples that may apply.

4. Which of the following are you currently participating or have participated in the past? Please select all that apply and provide a brief example of your participation.

5. What do you hope you will gain from joining WomanACT’s Membership?

6. Do you have any other comments you would like you to add to this application?