Register for The Koa Club

Name*

First Last

Username*

Email*

Enter Email Confirm Email

Please identify your gender identity:*

The Koa Club welcomes women and individuals who self-identify as women to apply for membership at The Koa Club, including non-binary or gender nonconforming individuals or those who were assigned male at birth, but in each case self-identify as a woman. The Koa Club does not accept applications from men or those who identify as men. Our community values the range of identities that the member body represents.

Woman or identifies as a Woman

Man or identifies as a Man

Phone*

Address*

Street Address City State ZIP Code

Your Age (Please select an age range that applies)*

Highest Level of Education (Please select a level that applies)*

Current Employer*

Current Job Title*

Your Proudest Achievements (Professional or Personal) (Optional)

How did you hear about The Koa Club (select one)*

If someone referred you to The Koa Club, please identify them here (if none, leave blank):

Main reasons for joining The Koa Club (Please check all boxes that apply)*

Meet new friends

Learn or try new things

Improve existing skills

Network for career

Give back to community

Share my experience

Associate with a cool club

No idea but why not?

Other

Name 3 professional or personal life skills that you would like to learn?*

Note: If there is enough interest from other members to learn these identified skills, The Koa Club may consider curating workshops for such requested skills.

Signed*

I agree and accept.

By applying for membership in The Koa Club, I agree to the Terms of Use and Privacy Policy. Once admitted as a member of The Koa Club, I further agree to comply with the Membership Rules.

I understand that The Koa Club reserves the right, in its sole discretion, to make changes to such Terms of Use, Privacy Policy and/or Membership Rules without advance notice.

I further understand that submitting this application does not guarantee membership into The Koa Club.

register for the koa club

Use the following form to regiser for The Koa Club as a Community Member.

register for the koa club

Use the following form to regiser for The Koa Club as a Community Member.

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