Gold or Platinum Sponsor Membership – 2024-2025

    Gold or Platinum Sponsor Member Registration

    Thank you for supporting PWC with your sponsor membership!

    Please enter your name and other information AS YOU WANT IT TO APPEAR in the PWC Online Directory. Please help us by using appropriate capitalization, spelling, etc. Although we will try to correct any obvious mistakes, the membership database and directory are volunteer efforts, staffed by humans, and we will undoubtedly miss a few things.

    If, after submitting, you need to correct some information, or submit payment later, please DO NOT FILL OUT ANOTHER FORM. Instead, send an email to contact@pwc.org with the corrected information, or for payments, go to the Payments page (link is found at the top of the screen) and submit your payment.

    After completing this form, and clicking the "Submit" button, you will get a confirmation message that your information was submitted, and will be redirected to our payments page.
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    Type of Membership (select one):

    First Name (required)

    Last Name (required)

    Credentials (e.g. RN, MD, VRC, CDMS, etc. If none, please put "none.")

    Profession/Job Title (if none, please put "none.")

    Company/Firm (required)

    Please choose from the drop-down menu. If your company is not listed, please select "OTHER" and fill in your company name below. If you do business under your personal name, and do not have a company name, then please select "None."

    If "Other," please enter the name of your company (if none, please select "none" from the menu above, and leave this field blank:

    Email (required)

    Website

    Primary Contact Phone (required)

    Phone Ext (if needed)

    Fax

    Mailing Address Line 1 (required)

    Mailing Address Line 2 (optional)

    City (required)

    State (required)

    Zip Code (required)

    Service Category (required)

    Additional information: (It's just for you to add anything you want us to know! Or you can just skip it. Either way, we won't publish what you put in this box.)

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    INTEREST INVENTORY:
    Optional!

    Program/Speaker suggestions:

    I would like to help with: (check as many as apply)
    Website
    Event Planning
    Event set up and check-in
    Directory preparation and publication
    Membership and Sponsorship Drives
    PWC History Project

    I am good with: (check as many as apply)
    Computers
    Finances
    Mail merge
    Websites
    WordPress
    Fund Raising
    Computer graphics
    Marketing
    Flower arranging
    Public speaking
    Negotiations

    Other Comments or Suggestions:


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    PAYMENT:

    I will pay by (select one):

    If "Other" was selected, please explain below:

    Spam sorter: Please answer the following question: