Individual Membership Application

Please complete the following application to join Wine Women. You will have an opportunity to correct any typos in your member profile later.

Please click the radio button by 'Individual Membership' (Required Field)

Individual (1 Year) - $165

Individual (2 Year) - $300

Please check if you would like your membership to automatically renew

Applicant Information

First Name: Last Name: Email: Personal Phone: Home Address: City: State: Zip Code: -

Company and/or Employment Information

Note: If you work for a winery with a parent company, please specify your direct employer.

Current Employer Job Title How Long Employed? Employer Address City: State: Zip Code: - Business Phone Work Email (if different than above) How did you hear about us? If you selected 'Other', please specify If you were referred, please tell us by whom?

Please setup your Member Login

Thank you for completing our application. Please setup your membership login at this time. Please note that your password must be a minimum of 8 characters and include one number.

Please make a note of your user name and password! After you complete payment on the next pages, you will be taken to a login screen where you can login to the WINE WOMEN membership portal to update your membership and view the member directory.