The Membership ApplicationPlease fill out all fields to submit your application Name * First Name Last Name Email * Please use the email address you'd like us to contact you at Phone * (###) ### #### What city do you live in? * Linkedin URL * Date of Birth * MM DD YYYY Please share your current company * Please share your current title or position at your company * Stage of your career or business * Early Growing Established Leadership Level Tell us why you'd like to become a member, and how would you use your membership, and what you could add to the community. * Have you attended a Her Story Uncorked event before? * Yes No Would you like to be considered as a mentor or speaker in the future? * Yes No Maybe We’re building a community of ambitious, kind, and genuine women who believe in connection over competition. Is that something you value, too? Yes, that sounds like me. Thank you!
