About you

Title - required

First name - required

Last name - required

Your email - required

Confirm email

Your contact number - required

Your current company - required

Your title - required

Your role - required

Your LinkedIn profile - optional

Your Facebook - optional

Your Twitter details - optional

Please upload a short CV- Word.doc or .PDF files only, max 3MB -required

How did you hear about CWN? - required

Please list the CWN events* you have attended (*minimum of two)- required

Proposer* (full name)- required *(please ensure you have obtained prior agreement from your proposer)

Proposer (email) - required

Seconder* (full name)- required*(please ensure you have obtained prior agreement from your seconder)

Seconder (email) - required

Please tell us why you wish to become a CWN Member (maximum 350 characters ) - required

As a member, would you be interested in joining one of our Committees? If so, please indicate which:

Please enter the correct answer

Please check the box to send your application