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     Click here on Membership Application to print the form below.


                          Capital Region Women's Network 
                 A local chapter of New York State Women, Inc.

                                       MEMBERSHIP APPLICATION

Applicant Information:

Name:  ____________________________________________________ 
Title:    ____________________________________________________
Company Name:  ____________________________________________
Work Address:   ____________________________________________ 
City, State, Zip:   ____________________________________________
Work Phone:       ____________________________________________
Email:                    ____________________________________________ 
Home Address:  ____________________________________________
City, State, Zip:   ____________________________________________
Preferred Mailing Address:  ____ Home   ____ Work
Home Phone:      ____________________________________________ 
Email:                   ____________________________________________

Dues Requested:
Capital Region Women's Network:   $60  (includes membership in New York State Women, Inc.)

Dues may be remitted to:
Capital Region Women's Network
P.O. Box 391
Delmar, NY 12054

New York State Women, Inc. promotes full participation, equality, and economic self-sufficiency
 for working women

The objectives of NYS Women, Inc., are to elevate the standards for women in business and the professions, promote the interests of business and professional women, bring about the spirit of cooperation among business and professional women in the US, and extend opportunities to business and professional women through education.

Our membership is open to women and men who are actively engaged in business or in the professions and who support the objectives of NYS Women Inc.

Privacy Policy Notice: The Capital Region Women’s Network may be contacted via This website and the Cornelia A. Bregman Scholarship does not collect any information from site visitors and does not share any student information with any other organizations. Students are not automatically enrolled to receive extraneous emails and/or solicitations of any kind. No distribution lists are created or maintained from this website or from any submitted application materials. Any further communication must be initiated by the applicant, and your email address will not be maintained or used for further communication or distribution.