Office
Use Only:
Date/To _____________________
__________ New _______ Renew
__________ Pr. only ____ Pr/card
Note: ________________________
|
WOMANSPACE MEMBERSHIP FORM
Name
________________________________________________________
Address
______________________________________________________
City ________________________ State
__________ Zip _______________
Home Phone _____________________ Work
Phone ___________________
Email
________________________________________________________
Job Title ________________________
Place of Work __________________
_________ Membership fee enclosed.
|
Check one: |
___
1yr/sustaining/$75 |
___
2yr/sustaining/$120 |
___
3yr/sustaining/$225 |
|
___
1yr/regular/$50 |
___
2yr/regular/$90 |
___
3yr/regular/$150 |
| (Your
membership fee covers a 1, 2, or 3-year period, beginning with the
month in which fee is paid. If you opt for a sustaining membership,
please know that we are grateful for your additional support.) |
______ Additional donation of $_______
enclosed.
Womanspace is a 501 (c)(3)
organization. Donations are deductible to the extent and in the manner
provided by law.
|
I would like to
help with:
| ___
Membership Committee |
___
Women's Golf Playday Committee |
___
Outdoor work |
| ___
Building & Grounds Committee |
___
Program/Marketing Committee |
___
Prairie/Labyrinth
work |
| ___
Reach for the Arts Committee |
___
Mailing Committee |
___
Other:
|
| ___
Spring Benefit Committee |
___
Office work (typing,
phone, filing) |
| ___
Glitzy Garage Sale Committee |
___
Library work |
|
|
|
|
Please send check and
membership form to:
Womanspace CENTER • 3333 Maria Linden Dr. • Rockford, IL
61114-5491 |