Advancing Advocates Council – Membership Application Join us to build safer communities! Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Employer*Employer Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Preferred Phone*Preferred Email* How did you hear about this opportunity?*Why do you want to participate?*Are you a member of any professional associations, peer networking groups, or social clubs?* Yes No Please list.Can you commit to attend monthly meetings?* Yes No Comments:Have you ever used any of The Women's Center's services?* Yes No Were you a client within the last five years? Yes No As noted in the Advancing Advocates Council Overview, all members will undergo a background check as part of the selection process. Have you previously volunteered with The Women's Center, and undergone a background check as part of your volunteer experience?* Yes No. (IF NO: A background check authorization form will be sent to you upon receipt of your application.) What is your age? 18 - 24 25 - 34 35 - 44 45 + I would like to be considered for participation in The Women’s Center’s Advancing Advocates Council. By submitting this application, I certify that all the information contained herein is true and correct to the best of my knowledge. I authorize The Women’s Center to perform a background check as part of my application process. If selected to participate, I agree to release my name and image to be included in promotional materials.* First Last Date Date Format: MM slash DD slash YYYY If you haven't previously submitted, please upload a current resume, including education, employment history, and volunteer involvement, or, email resume to annac@twcwaukesha.org.
