Today's Date: ___/ ___ / 2003
Please Print out this Form and
bring it with you to our next Meeting
First Name:
____________________________________________________________
Last Name:
____________________________________________________________
Email:
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Street Address:
____________________________________________________________
City: _________________________ State:_________________________
ZIP Code: _____________________
Home Telephone: (____) _______ -
_______
Work Telephone: (____) _______
-________
Member since (approx.
Month/Year):
_____ / ____ / ______
I would like to receive sponsor
e-mail:
Yes / No
I would like to volunteer for (Please
check all that apply!):
|
Membership
Committee |
|
Catering
Committee |
|
Publicity
Committee |
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Library
Committee |
|
Program
Committee |
|
Newsletter
Committee |
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Sponsor
Relations Committee |
|
Web
Committee |
|
Other
_______________ |
Comments:
_______________________________________________________
_______________________________________________________
_______________________________________________________
Please Check One:
New Member Application (w/$20)
Membership Renewal (w/$20)
Professional Certificates:
________________________________________________
________________________________________________
________________________________________________
________________________________________________
______________________________________________________ |