Please accept my membership in
The Women’s Roundtable, Inc. I agree to pay the annual membership dues
of $75.00 which entitles me to one free ticket to the annual Woman
of the Year dinner event. My check for this year’s dues is attached.
I also agree to abide by the Bylaws of the Roundtable.
_________________________ ________________________
Signature Date
Please complete
the following information and mail the entire agreement with your check
made payable to The Women’s Roundtable to P0 Box
3922, Erie, PA 16508.
Personal Information
(Member/Sponsor's Name If Applicable)_______________________________
Full Name _____________________________________________________
Home Address __________________________________________________
Home Phone ____________________________________________________
Volunteer Work________________________________________________
Education _____________________________________________________
Memberships in Other Organizations
_________________________________
_____________________________________________________________
Volunteer Work ________________________________________________
Hobbies ______________________________________________________
Other Interests _________________________________________________
Spouse & Children (if any)
________________________________________
Professional Information
Profession/Title _________________________________________________
Business/Company Name _________________________________________
Business Address _______________________________________________
Business Phone _________________________________________________
FAX # ___________________________
Email Address ______________________________
Mail should be sent to me:
____at my home address ____ at my
business address (please check one)
Phone calls should be directed
to:
____ my home ____ my business (please
check one)
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Interest Survey