Membership Application Please provide the following contact information: (* required)Name* First Last Street Address*City, State, Zip Code*Home Phone*Work Phone*Mobile PhonePagerEmail* FaxDegree InformationSelect all of the following degrees that apply, and indicate the corresponding college and major or field of study.* AA AS BA BS MA MS PhD Please list colleges/universities and majors.*Additional InformationOccupation (present or past)EmployerCurrent Work Status (check all that apply) Paid full-time job Paid part-time job Entrepreneur Volunteer Student Seeking work Retired Homemaker Other If other, please explain:Age 20-30 31-40 41-50 51-60 61-70 71-80 81+ Spouse/Significant OtherFamily Members' Names and DOBsInterests: Public Policy Programming and Planning Finance and Fundraising Sister-to-Sister Women's History Month Forums Communication and Visibility Membership and Outreach Social Committee Crystal Award Educational Foundation Other InterestsDuesMembership Type* Branch Member -- Associate's or higher degree - $72.00 Student Affiliate -- currently enrolled in a 2- or 4-year college degree program - $30.00 Additional Tax-Deductible DonationsEducational Foundation Legal Advocacy Fund Total $0.00 Today's Date* MM slash DD slash YYYY Δ
