New Page 1
PEI Business Women's Association
Member Login
New Page 1
Untitled 1
Join Us
Business/Personal Profile
Membership Type *
 
Member Name 
Name of registering person
or business to be displayed
in member directory.		 *
 
Business Category
Select all categories that
best describe your
business or profession.

(to select more than 
one category, hold down 
the Ctrl key when 
making selections)		 *
Other Business Category
 
  If you are applying for a Business, Reciprocal, or Provincial Patron membership, please supply the below information for your business.
Phone *
Other Phone
Fax
Email
 *
PEIBWA communicates with our members by email only so please provide a valid email address.
Street/PO Box *
City/Town *
Province *
County *
Postal Code *
Website http://
 
Description *
Give a 30 to 60 word description of yourself and/or your business. This will be displayed as part of your membership profile, visible on this website and the Member Extranet.
 
 
Do you wish to have your member profile listed on this website?
*yes  no
 
How did you hear about the PEIBWA?
* 
 
What is your method of payment?
*cash  cheque  Visa  Mastercard  debit
 
Are you interested in serving on a PEIBWA committee?
*yes  no
 
Main Contact
First Name *
Last Name *
Position *
 
contact information below, same as above
Phone *
Other Phone
Fax
Email
Street/PO Box
City/Town
Province
Postal Code
 
Extranet Access
In order to access the Member Extranet, select a username and password of your choice.  Once your application has been approved, you will receive confirmation that you have access to the Extranet.
Username *
Password *
Re-type Password *
       
Please enter the number you see in the box below *




home
© 2010, PEI Business Women's Association, Property database. Site by Web Site Advantage