Membership Form

(This page is secure)
Planning to join and sign up for a trip at the same time? You can do both on the Space Reservation Form
Required fields are indicated with an asterisk *

Information we need to know about you
First Name *

Last Name *

Nick-Name
(Do you have a nick-name you'd prefer to be called by?)

Email *
(Verify that your email address is correct!)

Address *

Apt #

City *

State/Province


ZIP/Postal Code *

Country *
(Enter your country if other than USA)

Primary Phone *
(Include area code)

Travel Phone
(Include area code; otherwise leave blank if no cell phone.)
  
(MM/DD/YYYY)


How did you hear about us?

Membership Information
Is this a New Membership or a Renewal?*




(Your renewal date begins the day after your current membership ends)

Choose Your Membership Length:*



Do you have a Referral Code?
(enter referral code)

Were you referred by a friend?
(enter first and last name)

Membership Auto-Renewal Information
As a service to our members, Women Traveling Together will send you an email - to the email address provided above - 30 days before your membership is due to expire and give you the option to cancel. If you do not cancel, your membership will be renewed for one year at the current membership rate.
Payment Information (This is a secure site)

We accept MasterCard, VISA, American Express and Discover

Card Number *
(Enter the card number with no spaces)
Expires:MM *
YYYY *

Card Verification Number *

(3 digits on reverse for MC, VI, DC; 4 digits on front for AX)

Special Instructions

A confirmation page will appear after your membership is received.
We will also send you a confirmation to the email address you provided.

Got Questions???
1-800-795-7135 in US
1-443-458-5634 outside US
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