Women Helping Women
Membership Application
All Information is Absolutely Confidential
Required
Date: 5/26/2017
Type of Membership: Individual Student Corporate
Sex: Female Male   Race/Ethnicity:  
Involved in: Movies Television Music New Media   Other: 
Number of years in the industry: 
Do you currently earn a living in the entertainment industry:  Yes No Part-Time

Full Legal Name: 
Professional Name: 
Name to apear on membership card: 
Profession: 
     Company Name: 
     Company Type: 
     Your Title: 
Mailing Address: 
     Suite No: 
     City/Town: 
     State/Province: 
     Postal Code: 
     Country: 
Contact Phone 1: 
     Contact Phone 2: 
Email Address: 
Websites and Blogs
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REPRESENTATION:
  Name 1:     Agent     Manager     Attorney 
  Name 2:     Agent     Manager     Attorney 
  Name 3:     Agent     Manager     Attorney 

Membership Affilliations (Unions/Guilds/Organizations)
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CONTACT INFORMATION FOR PUBLICATION

WHW may provide the following checked information for distribution to:
Members = WHW Members Only • Public = Others (including WHW Members) • Private = Office Use Only
Information Members  Public  Private
Company Name
Work Address
Mailing Address
Representation Info
Websites
Information Members  Public  Private 
Email Address
Work Phone
Work Direct Line
Contact Phone #1
Contact Phone #2

FOR OFFICE USE ONLY:
Career Objective:
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Special Skills or Expertise:
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Hobbies/Interests:
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Special Awards or Noteworthy Credits:
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List any Professional Connections or Resources you have in Hollywood:
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Why do you want to join WHW?
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What do you bring or intend to bring to WHW and its membership?
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What do you hope or expect to get out of your membership in WHW?
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What was the most recent thing you did to help another woman in the entertainment industry?
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WHW MEMBER INVOLVEMENT:
WHW Member Mentoring Requirement:
WHW members MUST participate in Project Reach Up, Reach Out & Reach Back™, a WHW mentorship program,whereby members commit at least 15 HOURS, in each year that membership is current, to reaching out and mentoring one or more WHW members in need of assistance.
I would like to be a mentor to (specify e.g., writer, producer, make-up artist, cinematographer, etc.):
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I would like to: be mentored by and/or Intern with:

I would like to VOLUNTEER to:
help PLAN/PRODUCE WHW programs/events secure SPEAKERS for WHW programs/events
secure VENUES for WHW programs/events secure SPONSORS WHW programs/events
MARKET WHW programs/events secure MENTORS for WHW membership
start   head   be part of a group or subgroup dealing with: (Specifiy area of interest):
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I would like to VOLUNTEER to:
HOST Small WHW programs and events consisting of no more than people at my:
Home Office  Other:
HOST/EMCEE   MODERATE WHW events  
BE A SPEAKER PANELIST at WHW events relating to (specify area of interest or expertise):
INTERVIEW influential women I admire for WHW e-magazine and/or other WHW media projects
WRITE articles/features for WHW e-magazine & other WHW projects

WHW EVENTS – MOST WHW events are FREE OR DISCOUNTED to members!!
I would like to attend events featuring speakers on:
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I would like to attend workshops or seminars pertaining to:
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I Can   I Prefer   I would like to attend   Night-Time Events  
I Can   I Prefer   I would like to attend   Day-Time Events  
I Can   I Prefer   I would like to attend   Weekend Events   Sat  Sun 
Other (I would like to see WHW get involved in:)
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REFERENCES: PLEASE LIST ONE BUSINESS AND ONE PERSONAL REFERENCE
Name of ReferenceRelationshipPhone (w/area code)
1.
2.
WHW Sponsor:
I do not have a sponsor. I wish to waive this requirement because:
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I understand that all WHW membership applications are subject to review.
I have read and accept the Code of Ethics and Terms and Conditions for Women Helping Women membership and hereby sign the Member Pledge.
(View WHW Pledge)