Membership Application

Thank you for applying for a membership with Titans of the Midwest. In filling out the application below, we ask for your legal first and last name. This legal name is kept "behind the scenes" and will not be published. You are welcome to also add a nickname that we will use when referring to you publicly. Membership dues will be collected after your membership is approved.

Click here to review our membership categories and guidelines.

Membership *

Full Member - $ 30.00

Associate Member - $ 30.00

Recruit Member - $ 30.00

Total Amount

Email Address *

Account

Please enter a Username to create an account. If you already have an account please login before completing this form.

Username *

Check Availability
Punctuation is not allowed in a Username with the exception of periods, hyphens and underscores.

Password

Confirm Password

Provide a password for the new account in both fields.

Membership information

First Name *

Last Name *

Provide a nickname you don't mind being public.

Nickname

Pronouns *

Street Address (Home)

City (Home)

Postal Code (Home)

Country (Home)

State (Home)

Phone

What region do you live in? North: MN, WI, MI, Chicago Metro East: IL (other than Chicago), IN, OH, KY West: NE, IA South: KS, MO, OK

Region (drop down)

Birth Date *

How did you hear about the Titans of the Midwest? *

Details of how you heard of us:

Interest in Titans:

Please describe your interest in the Titans of the Midwest and why you want to be a member.

About me.

Please tell us about yourself. The Executive Committee typically does not approve applications if we don't know you or you don't provide information about your interest in our organization. Please include other groups you are a member of.

Pin Delivery:

Mail It To Me Receive In Person

Upon approval, you are granted a Titans of the Midwest pin. We can either mail this to you (no shipping charge), or give it to you in person at an event or function. Please indicate your preferred delivery method.

Are dues a financial burden?

Yes No

If the $30 annual dues is a significant financial burden for you, please describe your situation and how you will volunteer for the Titans of the Midwest in the coming year to compensate for the dues.

Dues Exemption

If you stated that dues are a financial burden above, please describe your situation and how you will contribute to the Titans of the Midwest over the coming year.

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