MEMBERSHIP FORM

Print and complete this form and send it along with your check for $70.00 ($46 of which is tax deductible), made payable to the Fox Chapel Area Branch – AAUW.  Annual dues are due by June 30th, the beginning of our fiscal year.  Mail the form and the check to: Alice Scott, Financial Officer, 106 Chapel Crest Terrace, Pittsburgh, PA 15238

Please consider a voluntary, additional donation to the FCA AAUW Education Fund.

Please provide the following information for the Directory.  This is your chance to make corrections and additions to the existing Directory.  If there are no changes in your previous listing, only the starred and underlined are required.

* Name (Last, First) and Spouse’s Name, if you wish:                                                                         

Dues                                                                                                                                  $ 70.00

Voluntary donation to FCA Education Fund                donation amount  $          

*Check here if listing remains the same as last year, no changes or additions

Telephone with area code                                                                                                             

Cell Phone                                                                                                                                           

Street Address                                                                                                                                   

City, State, Zip                                                                                                                                   

Email address                                                                                                                                     

The Chapel Crier newsletter will be emailed to you unless you check here to receive it by U.S. Postal delivery. 

Educational information (schools and degrees):

                                                                                                                                                           

                                                                                                                                                           

Birthday (year not needed, only for Happenings):                                                      

Suggestions for programs (topics, panel discussions and/or speakers): 

                                                                                                                                                           

                                                                                                                                                           

Current interest groups include: Arts & Entertainment, Book Group, Bridge Group, Bridging Generations, Education Action Committee, Golf Group, Mid Day Matinee Movies, Out-to-Lunch Bunch, Women in Stitches, Vision Screening. 

Have you any suggestions for other interest groups in 2012-2013? All you need are 3 people to start a group!

                                                                                                                                                                                   

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