Association
for Women in Computing
41 Sutter Street, Suite 1006
San Francisco, CA 94104 USA
Independent membership application
First
name ___________________ Last
name _____________________
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Address __________________________________________ |
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City __________________
State _____ Zip ___________ |
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Country ________________
Phone ________________ |
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Profession _________________________________________ |
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Company ___________________________________________ |
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Address ____________________________________________ |
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City __________________
State _____ Zip ___________ |
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Country ________________
Phone ________________ |
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Email _______________________________________________ |
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Indicate Preferred Postal Mailing
Address: __ Home __ Work |
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List in Directory: __Home
__ Work __ Both __ Neither |
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ICCP certifications:
__Certified Computer Professional __Other |
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I heard about AWC from:
__AWC Member __Friend __Trade Fair __Article __Web Page
__Ad
Please list specific source ______________________________Send $25.00 in US currency check or money order payable to AWC.
Annual dues are for the membership period July 1 to June 30. Dues received on or after
April 15 will be applied to the following membership year. AWC is a non-profit US
501(c)(6) corporation, Federal ID 52-1147582.
Signature:
________________________ Date:_____________ |
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