Membership Application

Welcome! This application process will require approximately 20 minutes to fill out, it includes information about yourself that we can include in your profile and demographic statistics. Please note the following

  • Head shot is required
  • Short bio so we can build your profile
  • Application must be complete in one sitting
Membership Application
Address
Line 1
Line 2
City
State/Province
Zip/Postal
***please note if self employed

What do you find most valuable?

1 - Not Interested 3 - Indifferent 5 - Very Interested
The opportunity to share personal and professional knowledge through Women In Rural's (WIR) blog, newsletter, and social media.