MEMBERSHIP APPLICATION,  MARCH, 2011 - JUNE 15, 2012 AMERICAN  ASSOCIATION  OF  UNIVERSITY  WOMEN,  FREMONT,  CA DATE: _________ __ ____
	PERSONAL INFORMATION
	First Name:   __________________________________________		Last Name:   ___________________________________________
	Street: ___________________________________________		City,State,Zip: ____________________________________________
	Home Phone:______________________________		Cell Phone: ________________________________
	Home Email:  _______________________________		Work Email:  _______________________________
	Employer:  ______________________________		Occupation :  ______________________________
	Passions and Pursuits ___________________________________________________________________
	School    Associate_______________________________    Bachelors_______________________________    Masters_________________________________    Ph.D.___________________________________		Specialty ___________________________________Year_____ ___________________________________Year_____ ___________________________________Year_____ ___________________________________Year_____
	Please indicate whether you are a new __ or a returning __ member.       If you are coming from another AAUW branch, which one?  _______________________       Who referred you to us?_______________________
	DUES
	Member  $81,    $46 Tax Deductible      Student  $43		$49 National + $16 State + $16 Branch = $81
	DONATIONS
	Tax Deductible Donations     Enter light name only in memo on check     AAUW Funds - Education Foundation     AAUW Funds - Legal Advocacy Fund     AAUW Fremont - Local Scholarships     AAUW Fremont - Tech Trek Scholarships		Taxable Donations     Enter light name only in memo on check     AAUW Fremont Branch - General Fund
American Association of University Women, Fremont Branch, P.O. Box 8254, Fremont, CA 94537-8254 Call 510-728-9700 for a Roster Photo Appointment, or other information.