Name ___________________________________________________________________________
Street _____________________________ City _________________________ Zip ___________
Home Phone ____________________ Office Phone ____________________ Ext. ________
Email __________________________________________________________
Elected Office, if any _________________ Jurisdiction __________________ Term Ends_______
Employer ____________________________ Position/Occupation ___________________________
Check Type of Membership
Regular Member $35 ______ Emerita Member $25 ______ Associate Member $25 ______
(elected official) (former elected official) (everyone else)
Print this form out, complete it and mail with your check to
WON
PO Box 404
Birmingham, MI 48012-0404
_____________________________________________________________________
2011-2012 WON Membership Form
|
New _____
Renewal _____
Women Officials' Network
PO Box 404
Birmingham MI 48012-0404
248.335.7637
© Copyright Women Officals' Network 2011
|