Woman’s Life Insurance Society – Application for Social Membership

I apply for social membership in Woman‘s Life Insurance Society. I will comply with the Articles of Incorporation and Laws of the Society, as amended. I will advance the welfare and progress of the Society and its principles of connection, community, and cause.

Information About the Applicant

Name
- First Name
- Middle Name
- Last Name
Address
- City
- State
- Zip Code
Date of Birth
- Month
- Day
- Year
Home Phone
Mobile Phone
Email Address
Initials (in lieu of a signature)
I agree to Waiver & Release of Liability
Join Existing Chapter
- State
- Number
Recommending Chapter Member #1
- First Name
- Last Name
Recommending Chapter Member #2
- First Name
- Last Name

Yes! Please contact me about:

Protecting my family and assets with life insurance
Including an annuity in my retirement savings plan

Billing Cycle

Annual – $20 per year

Payment Options

Automatic Payments (Recommended)
I hereby authorize Woman’s Life Insurance Society to charge my credit card account for the Automatic Credit Card Payment for Social Member Dues as outlined in the Automatic Credit Card Payment Service Agreement & Authorization.
Manual Payments
I hereby authorize Woman‘s Life Insurance Society to charge my credit card account for a one-time payment of $20 for Social Member Dues.

Credit Card Payment Authorization

Please note: Chapter officers and members may not accept dues payments and should not have access to a member’s payment information. To join online, the new member should complete the credit card information section below. Dues are not deductible as a charitable contribution.

Card Type
Card Number
Expiration Date
- Month
- Year
Cardholder’s Name
Security Code 3 or 4 digit number on back of card
Phone
Use applicant address for billing address
Billing Address
- City
- State
- Zip Code

Automatic Credit Card Payment Service Agreement & Authorization

Thank you for becoming a member of Woman’s Life Insurance Society (“Woman’s Life” and/or the “Society”)! This Member Service Agreement sets the terms and conditions of your enrollment in the Society’s automatic credit card withdrawal for a social membership.

Annual Social Membership Dues

The annual dues for a social membership in Woman’s Life is $20. Upon the purchase of a financial product with Woman’s Life, the social membership dues are waived. You will become a Social member of Woman’s Life on the date this application is received and processed by Woman’s Life. This will be considered your anniversary date. Ten (10) days in advance of every anniversary date thereafter, the full $20 membership dues will be automatically charged to the credit card number you have provided to Woman’s Life unless you notify us that you no longer wish to subscribe to this service thirty (30) days prior to your anniversary date.

Waiver & Release of Liability

By submitting an Application for Social Membership, and in consideration of my participation as a social member of Woman’s Life Insurance Society (“Woman’s Life”), I for myself, my heirs, executors, and administrators, waive all rights and claims for damages I may have against Woman’s Life, their agents, representatives, subordinate chapters, successors or assignees, of any Woman’s Life event that I may attend for any and all injuries suffered by me at that event, or which may arise out of my traveling to, participating in, and returning from any Woman’s Life event. I further state that I am in proper physical and mental condition to attend any Woman’s Life event.

I release the rights to any and all photographic and video materials that Woman’s Life or my chapter may publish from any Woman’s Life events without obligation to me.