Name

Title

Company

Address

City State Zip

Phone (W) (H)

Fax E-mail

Web Site

What is the best way to contact you?
Email Phone Fax Mail

What is your primary reason for joining Leading Ladies^®?
(e.g., Business/Career Development, Mentoring, Social)

How did you hear about Leading Ladies^®?

Membership Fee:
$120/year – Regular Annual Membership Fee

Method of Payment:
Check or Money Order Enclosed (Made payable to Tidings Corporation)

Please fill out, print and mail with Membership Fee to:

Leading Ladies^®
c/oThe Tidings Corporation
P.O. Box 6486
Arlington, VA 22206

Thank You!