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Member Application
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| Date:
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Your Name:
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| Home Address:
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| City, State, Zip:
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| Home Phone:
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| Home Email:
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Business Name:
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| Business Address:
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| City, State, Zip:
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| Business Phone: |
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| Business Email:
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| Important! Please specify where to send your membership confirmation and any other WIE communications. | ||||||||||||||
| Business Address and email | ||||||||||||||
| Home Address and email | ||||||||||||||
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MEMBERSHIP OPTIONS. Please check one.
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Annual Membership, $25.00 | |||||||||||||
| Student Membership, $12.50 | ||||||||||||||
| Renewal for |
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Please bring to a WIE meeting or Mail this form with payment to:
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Women In Electronics, P.O. Box 956213, Duluth, GA
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We are happy to have you join our dynamic group.
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