WOMAN Women Over 40 Meeting And Networking


	PO Box 10465 ~ Greensboro, NC 27404 336-254-5889

Membership Form Please print and fill out this form (please print) and return with your check to: WOMAN P.O. Box 10465 Greensboro, NC 27404 336- 254-5889 Dues are payable upon application for membership: $48.00 (if joining Jan - June) $24 (if joining July- Dec). Name_______________________________________________________________ Home Address_________________________________________________________ City___________________State_______Zip_____________Birthday_____________ Home Phone_________________________Cell Phone_________________________ Email Address_________________________________________________________ Your Company________________________________________________________ Company Address______________________________________________________ City___________________State_______Zip_____________Phone_______________ Nature of business - (be as specific as possible): ___________________________________________________________________ ___ Please check here if you DO NOT wish for your information to appear in our WOMAN directory. ___ Please check here if you DO NOT wish for your photo to be appear in the newsletter or on the website. Signature_______________________________________Date__________________ Please check area(s) in which you are willing to participate. ___Membership ___Publicity ___Newsletter ___Program ___Registration What topics would be of greatest interest to you?____________________________________ _________________________________________________________________________ How did you learn about WOMAN?_______________________________________________ __________________________________________________________________________