Associate Member Form

inform. educate. connect.


You may join WIB or renew your membership online with a Visa or MasterCard using the form below.

You may also join or renew your membership by printing out the following form and faxing or mailing it in:

Associate Membership Application & Renewal Form


PLEASE NOTE: Firms wishing to become a new Associate Member must submit an application that must be approved by the WIB Board of Directors. Correspondent banks may join WIB as an Associate Member. Payment is due at the time of application. Please read our Terms & Conditions prior to applying for membership for the first time.

Please be sure to fill out the information completely! Even if you think we already have your information, please take the time to update us with the correct information.

Not sure if your firm's membership is up-to-date? Click here for our current membership list.
  FIRM NAME

FIRM NAME

  MAIN CONTACT (will be listed in the Online Products & Services Directory)

Main Contact First Name

Main Contact Last name
Main Contact Title
Mailing Address
Address (cont.)
City
State   Zip Code 
Main Contact Direct Phone
Main Contact 

Direct Fax
Firm Main Phone  
Web Site  
 How did you hear about us?
E-mail  *Email addresses will ONLY be used for communications regarding WIB-sponsored, co-sponsored or endorsed programs. They will NOT be provided to other organizations for solicitation of you or your employees. They will be listed in our Online Products & Services Directory.
Check here if you do NOT want to be listed in our Online Products & Services Directory. If you are the only contact and check this box, your firm will not be a part of the Directory.

If this form was completed by someone other than the person listed above, please provide the following:
Prepared by:   
Phone:

Have you ever been involved in a legal conflict (initiated claim, arbitration, lawsuit, settlement, etc.) as either plaintiff or defendant, with an association or an independent bank? Yes   No 

Have you ever been denied membership or asked to withdraw from an association? Yes   No 

Have any of your products/services ever been endorsed by any financial services association? Yes   No

This is a new membership    This is a renewing membership

You may calculate your membership dues using the chart below:

WIB Associate Annual Dues Schedule
Membership Through 12/31/2012

Number of Employees Annual Dues Directory Listing 
Level 1: 1-5 $1,175 Main Contact
Level 2: 6-10 $1,325 Main Contact + 1
Level 3: 11-25 $1,425 Main Contact + 1
Level 4: 26-50 $1,575 Main Contact + 2
Level 5: 51-100 $1,675 Main Contact + 3
Level 6: 101-200 $1,875 Main Contact + 4
Level 7: 201-500 $2,150 Main Contact + 4
Level 8: 501+ $2,225 Main Contact + 4

Additional Contacts are available at any level of membership for $100 each 

Firms with Multiple Subsidiaries

Firms with multiple subsidiaries that join at the same time will receive 25% off the lowest membership dues cost.*

SAMPLE

Firms with Multiple Subsidiaries Formula

Subsidiary A Dues - 50 employees

$ 1,575

Subsidiary B Dues - 65 employees 

$ 1,675

Subsidiary C Dues - 115 employees

$ 1,875

Subtotal

 $5,125

Less 25% discount 

 $ 1,281.25

Total Dues

$ 3,843.75

If Paid Separately

Subsidiary A Dues - 50 employees

$ 1,575

Subsidiary B Dues - 65 employees

$ 1,675

Subsidiary C Dues - 115 employees

$ 1,875

 Total Dues 

$ 5,125

*Please note that all firms must join at the same time in order to be eligible for the multiple subsidiary discount.

Our current company size is employees. 

Based on the above chart, we qualify as Level .

Based on the above chart and inclusive of any current membership offers, our Dues Amount is $. 

 

Yes, I would like to enhance my membership!     Premier - $2,000 additional 

For a description of the Elite and Premier enhancements please visit our grid comparison, or you can contact the WIB Membership Department at (415) 352-2323 or membership@wib.org.

Level 2: One Complimentary Additional Contact
Level 3: One Complimentary Additional Contacts
Level 4: Two Complimentary Additional Contacts
Level 5: Three Complimentary Additional Contacts

Level 6: Four Complimentary Additional Contacts
Level 7: Four Complimentary Additional Contacts

Level 8: Four Complimentary Additional Contacts

Additional Contacts will receive all WIB mailings, a subscription to Western Independent Banker Magazine, a listing with contact information in our searchable Online Products & Services Directory, and all seminar and conference exhibit opportunity announcements.

  CONTACT #2 (Complimentary for Levels 2-8; $100 for Level 1)

Name
Title
Mailing Address (If different than above)
Address (cont.)
City
State   Zip Code 
Direct Phone
Direct FAX  
E-mail  
Check here if you do NOT want this person to be listed in our Online Products & Services Directory. 

  CONTACT #3 (Complimentary for Levels 4-8; $100 for Level 1-3)

Name
Title
Mailing Address (If different than above)
Address (cont.)
City
State   Zip Code 
Direct Phone
Direct FAX  
E-mail  
Check here if you do NOT want this person to be listed in our Online Products & Services Directory. 

  CONTACT #4 (Complimentary for Level 5-8; $100 for Level 1-4)

Name
Title
Mailing Address (If different than above)
Address (cont.)
City
State   Zip Code 
Direct Phone
Direct FAX  
E-mail
Check here if you do NOT want this person to be listed in our Online Products & Services Directory. 

  CONTACT #5 (Complimentary for Level  6-8; $100 for Level 1-5)

Name
Title
Mailing Address (If different than above)
Address (cont.)
City
State   Zip Code 
Direct Phone
Direct FAX  
E-mail
Check here if you do NOT want this person to be listed in our Online Products & Services Directory. 
NEW MEMBER APPLICANTS ONLY: CLIENT REFERENCES

THIS SECTION FOR NEW MEMBERS ONLY: If you are renewing your membership, you may skip this section. Please list three (3) client references, preferably independent banks. References must be provided in order for application to be processed. If you are a startup with few clients, please list any references that can attest to your business knowledge and focus.

  REFERENCE #1
Firm

Name
Title
Address
City
State   Zip Code 
Phone
Email WIB does not sell or rent email addresses

  REFERENCE #2
Firm

Name
Title
Address
City
State   Zip Code 
Phone
Email WIB does not sell or rent email addresses

  REFERENCE #3
Firm

Name
Title
Address
City
State   Zip Code 
Phone
Email
NEW MEMBER APPLICANTS ONLY: COMPANY DESCRIPTION

Please submit a 75-word (maximum) company description for use in our Searchable Online Directory.  

Business Lines 
(select all that apply by holding the Ctrl key while clicking on each item)

Payment Information

I will pay my firm's Dues amount noted above using (please check one):

Visa       MasterCard                  

Account Number   Expiration Date  CCV
Cardholder name

I will mail check. If this is selected, please print out this form and submit a check payable to Western Independent Bankers. Application cannot be processed until payment has been received.

Western Independent Bankers
601 Montgomery Street, Suite 1200
San Francisco, CA  94111

You will receive confirmation via e-mail. Please be certain your e-mail address is correct above.