Women of the Midwest Membership Form
Please fill this section out completely with all of your contact information.
Are you a current member?
Date of birth
How did you learn about us:
My friend is a member (please share with us the name of your friend in the additional comments section)
I ran into your website!
I heard about you on radio/TV!
None of the above (please share with us how you found us in the additional comments section)
Do you have a passport?
Passport expiration date
How would you like to pay for the $100.00 membership fee?
Checks can be made out to Executive Travel. Mail your check to:
Attn: Group Department
1212 O Street
Lincoln, NE 68508
Name on Card
Credit Card Type
Credit Card Number
Security code (CVC code)
PIN Number (if applicable)
Expiration Date (mm/yy)
Thank you for renewing your membership with Women of the Midwest.
Thank you for becoming a member of Women of the Midwest, we will contact you via email within 2 business days.
Please check your inbox and spam-box for emails from
; add us to your address book.