Women in Bio - Membership

Membership Application

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Membership Application

Women In Bio, a non-profit corporation, offers educational programs in order to improve access to important know-how and to industry members. Membership is open to all professionals and students.

Please note: we do not accept American Express or Discover credit cards.

Check Payment:
If you prefer to pay by check, please print out this form and mail with your payment to:
Women In Bio, Inc.
P.O. Box 34043
Bethesda, MD 20827

WIB - Membership Application and Credit Card Form

Please check the membership category below that applies to you:

*Individual Memberships*
General Membership $150 Student $50	(If you are just starting your own company, you may qualify for our special sponsored membership rates. For information on sponsored memberships, corporate memberships, or the committees, please contact Sue Hendrickson at .)
*Corporate Memberships*
Corporate Membership $2,500 Allows all company employees to attend member events and attend general events at the member rate.
*Organizational Memberships*
Organizational ($350 for three organizational members; $100 for each additional)

A bio company is one that is developing or manufacturing products or processes involving intellectual property in the life sciences fields.

Please indicate if you are a: Bio Company Executive

Bio Company Founder & Executive

Please indicate if you are a: Female

Male

Choose your country:^*

Salutation^*

First name^*

MI

Last name^*

Job Title^*

Company or Institution^*

Street Address^*

Address (continued)

City^*

State^*

5-Digit zipcode^*

City/Town^*

Province^*

6-character postal code^*

Daytime phone^*
() - Ext:

Fax
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City/Town

Province/Territory

Postal code^*

Daytime phone^*

Fax

E-mail address^*

Company Website

I am interested in learning more about or serving on the following committee:

Program Committee
Membership Committee
Funding Committee
Communications Committee
Advisors Group Committee

For information on corporate sponsorship, please call Elizabeth Gray at (301) 263-1313.

PAYMENT INFORMATION
You will receive an e-mail confirmation of your registration.

Check Payment
If you prefer to pay by check, please print out this form and mail with your payment to:

Women In Bio, Inc.
P.O. Box 34043
Bethesda, MD 20827

Credit Card
We accept Visa and MasterCard. (American Express and Discover are not accepted.)
Enter the name and zip code that appear on your credit card statement,
and enter the e-mail address of the credit card owner:
Check here if your credit card billing name, zip code, and e-mail address
are the same as the name, zip code, and e-mail address you entered above.

^*Billing first name:

^*Billing last name:

^*Billing e-mail:

^*Billing zip/postal code:

Click here to go to our secure credit card processing server: