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Women's
Full Name
Women's Caucus Membership Type
Elected Official (+ $100)
Elected Official Affiliate (+ $150)
Municipal Staff (+ $150)
Community Member Affiliate (+ $150)
Small Business (+ $2,500)
Corporate Sponsor (+ $5,000)
Title
Organization/City
Email
Phone
Administrative Contact Full Name
Administrative Contact Email
Administrative Contact Phone
Total price (includes tax, shipping & handling):
$100
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