Name: _____________________________

E-Mail Address: _____________________________

Web Page:     http:// _____________________________

Home Telephone: _____________________________

Home Address: _____________________________

   City, State, Zip: _____________________________

Employer or School: _____________________________

Work Telephone: _____________________________

Work Address: _____________________________

   City State Zip: _____________________________

Where did you hear about AWC? ________________________________________________

Your address in National Directory: ___ Home   ___ Work   ___ Both   ___ Neither  

Include your name on the chapter's web page: ___ yes: include my   ___ URL   ___ Phone   ___ E-mail  

Title to use on chapter's web page ("Systems Analyst", "Recruiter", etc. etc.)

           _______________________________

We normally welcome and thank new members on our awc-talk mailing list.
If you would prefer not to be thanked in this way, please check here: _____

Areas of Expertise: __________________________________________________________

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What would you like to see AWC do: _____________________________________________

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Comments: ________________________________________________________________

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