Who We Are How to Join Program Priorities Resources Links to Organizations Member Center

Thank you for applying for membership to WG-USA!

INSTRUCTIONS (Please read carefully):

1. Complete this form and press SEND. (*) Denotes a REQUIRED FIELD.
2. When all the required fields are filled in, you will be given one more chance to verify your information before sending for the final time.
3. Upon successful filling in of this application, you will be prompted to select one of the payment options - check or credit card for $50 .
   

Already a Member? If you wish to modify your member record, please contact the Records Chair at records@wg-usa.org. Please include your membership number, your full name and address and a description of the information you would like to change.

The following field(s) are(is) required: First Name, Last name, E-mail, Granting Institution, Degree Held, Street, City, State, Zip, Country

Names: Miss Mrs Ms Dr

*First name :		*Last name:
	Your name as printed on degree (ie. maiden,married):

Address:

*Street
*City		*State	Select State Alabama Alaska Arizona Arkansas California Colorado Connecticut DC Delaware Florida Georgia Hawaii idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming None
Country		*Zip
Telephone:		Cell:
Fax:		*E-mail:
Professional Information
Profession:		Present Occupation:

Degrees(s) held:

Names of Granting Institutions	Degree held
1. * required	*required
2.
3.
4. Other Degrees Held:

Special Field(s) of Study	Interests and Talents
Do you belong to another affiliate of IFUW? If so which?
Languages Spoken (besides English):	Languages written (besides English):
International Connections or Memberships	How did you learn about WG-USA?

You have my permission to contact me by e-mail with membership renewal and membership meeting information stipulated in the WG-USA bylaws.

Declaration: I declare that I hold the degree(s) stated. I subscribe to the purposes of WG-USA as set out on this web site and will pay the annual membership dues of $50.

Information will be kept confidentional and will not be distributed
for purposes other than WG-USA Membership

...empowering women to secure a better world