Local Associate Application

Application for one year local affiliate membership in A&WMA - Lake Michigan States Section. If you are interested in a full A&WMA membership, you can join at http://www.awma.org and you will automatically be a local member (no action is needed here).
First Name 
Last Name 
Affiliation/Company 
Title 
Address 
City/State/ZIP 
E-mail 
Work Phone  xxx.xxx.xxxx
Home Phone  xxx.xxx.xxxx
=>  How did you hear about A&WMA-LMSS? Who can we thank?
=>  Why are you joining? (check all that apply):
Training
Education
Networking
 Information Resource
Relationship Building
Commercial Opportunities
Other
Membership  Membership dues are non-refundable and are due annually on the anniversary date of application. This application must be completed in its entirety.
Local Associate (includes Government Employee) $45 One Year
Local Student Associate $15 One Year
Optional Stephen Rothblatt Scholarship (enter a donation amount)
Payment:  
    To:  Lake Michigan States Section A&WMA
           11 Pleasant Hill Blvd.
           Palatine, IL 60067  
    Check Memo: - Your Name
-- OR --
Credit Card or Direct Withdrawal
(You will get a confirmation e-mail of this application.)

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