Membership Form 

inform. educate. connect.

You may join WIB or renew your current 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:

Bank Membership Application


To join or renew as an Associate Member, Click Here.

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

Please fill out the following information completely:

First name
Last name
Title
Bank/Firm
Mailing Address
Address (cont.)
City
State   Zip Code 
Phone
FAX  
Web Site  
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.
How did you hear about us?

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

Our Current Bank Asset Size is $ million. 

Please use the chart below to calculate your membership dues and choose which membership you'd prefer.

 WIB Dues Through 12/31/2012

Bank Assets Annual Dues
0-50 million $675
51-100 million $1,225
101-150 million $1,425
151-200 million $1,500
201-300 million $1,775
301-400 million $2,050
401-500 million $2,325
501-600 million $2,600
601-700 million $2,825
701-800 million $3,050
801-900 million $3,250
901-1 billion $3,400
1.1 - 1.5 billion $3,775
1.6 - 2 billion $4,000
2.1 - 3 billion $4,225
3.1 - 4 billion $4,350
4.1 - 5 billion $4,450
5.1 -  10 billion $4,500
10.1+ billion $5,000

De Novo Pricing:

First Year Bank Open Complimentary
Second Year  $250
Third Year $500
Fourth Year Normal Pricing

Payment Information
Based on the charts above, my WIB Dues Amount is $. 

I am also interested in the Season Pass for Learning (at an additional cost to my dues):

Gold-$4,550 
Silver-$3,550
Bronze-$1,550

I will pay the amount of my dues plus the amount for the Season Pass for Learning (if selected) amount using (please check one):

Visa       MasterCard                  

Account Number   Expiration Date  CCV  
Name as it appears on account

I will mail check. Please note: your membership is not valid until full payment is received. If you need immediate membership, please pay via credit card above. If you are paying by check, please print out this form and submit a check payable to:

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.