Membership Application

AMERICAN BUSINESS WOMEN’S ASSOCIATION

IRIS CHARTER CHAPTER 1620

P.O. BOX 654

EXPERIMENT, GA 30212

PLEASE NOTE: This application is only for “local” Chapter 1620, Griffin, GA membership and does not include the “National” dues. The National ABWA application with National dues information is available on request or can be found online at www.abwa.org. (Please note affiliation with Iris Charter Chapter 1620 when completing national form.)

Dear Prospective Member:

Please complete the following information and return to Iris Charter Chapter 1620 ABWA, P.O. Box 654, Experiment, GA 30212 with 1-year dues payment of $30.00, or you may bring it with you to our next chapter meeting. We will use this information to add you to our “Iris Chapter” Newsletter distribution list (by e-mail unless you request mailed copy) and to our local member roster, which is given to every member. The information will not be given to any other organization.

First name

Last name

Address

Home Phone

Mobile Phone

Birthday MM/DD

How would you like to receive our Newsletter?

US Mail

Place of Employment (if retired, last place of employment)

Title or Position

Other Place of Employment

How did you hear about us? (Event, Member, Web Search, etc.)

Thank you for your interest and we look forward to seeing you at our next meeting. If you have any questions, please contact: Rita Johnson, Membership Chair (404) 409-2154 Rita.Johnson.NL65@statefarm.com