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  BPD Form
  BUSINESS & PROFESSIONAL WOMEN'S ASSOCIATIONS

New Organization and Change Request Form

Please complete this form if you would like to be added to the Women's Commission Blueprint Directory or have changes for your agency or organization already listed. 

Thank you for helping keep our directory current and correct.This form may also be phoned in or faxed to our office.  Phone Number : (704) 432-6933 Fax Number : (704) 432-1197

If you are entering a new organization, please fill out the entire form.

If your organization is already listed in the Blueprint Directory,  please fill in the required fields and then only those fields that have information changes.

New Organization Request
Information Change Request
Person Submitting the Request (required):
Contact Phone Number (required):
Contact e-mail (your e-mail):
 
Association/Organization/Agency Information
Association/Organization/Agency Name (required):
National Affiliation:
 
Primary Contact Information
Primary Contact Person (President):
Street Address:
City, State, Zip:
Telephone Number:
E-Mail:
 
Alternate Contact Information
Alternate Contact Person:
Telephone Number:
E-Mail:
 
Agency History and Data
Association/Organization/Agency WebSite Address:
Year Established:
Number of Current Members:
Meeting Dates:
Meeting Times:
Meeting Locations:
Membership Requirement (s):
Newsletter Published:
Yes
No
If "Yes" When?
 
Agency Purpose and Programs
Purpose and/or Mission of Association / Organization / Agency:
Vision:
Major Planned Programs / Projects / Services:
Other Information to Add:
 
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Master Agency List

ADD New Association or Agency to Blueprint Directory

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