AWC/PS Membership Application
To join the Association For Women In Computing/Puget Sound Chapter, please print and fill out
this form, then mail it, along with a check or money order to:
The Association For Women In Computing
Puget Sound Chapter
P.O. Box 179
Seattle, WA 98111
Ms. Mr. (Circle one)
First name:_____________________ Last name: __________________________
H
O
M
E
| Address: ____________________________________________ City: __________________ State: _____ Zip: ___________
Phone: ________________
|
W
O
R
K | Profession: __________________________________________ Company: ___________________________________________
Address: ____________________________________________
City: __________________ State: _____ Zip: ___________
Phone: ________________
|
O
T
H
E
R | Fax: ______________ Email: ____________________________
List in Directory: ___ Home ___ Work ____ Both ____ Neither
|
Please tell us a little about yourself so we can introduce you to our membership:
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
I heard about AWC from:
| ___ Friend ___ AWC Member
| ___ Trade Fair ___ Web Page
| ___ Ad ___ Article
| Please list specific source: ________________________
|
Remit dues using the following schedule:
Note: The membership year is July 1 - June 30. All memberships at the below prices expire June 30.
AWC/PS is a non-profit US 501(c)(6) corporation, Federal ID 91-1202821
| July | $60 ____ | Oct | $60 ____ | Jan | $45 ____ | Apr | $30 ____ |
| Aug | $60 ____ | Nov | $55 ____ | Feb | $40 ____ | May | $25 ____ |
| Sept | $60 ____ | Dec | $50 ____ | Mar | $35 ____ | June | $20 ____ |
Student Membership is $25 with valid student ID.
I agree to comply with the requirements, bylaws and regulations adopted by the Association.
Signature: ____________________________________ Date: _________________
| 
