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TBW Member Application Form

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                                                                                                                              Membership Application
                                                                                                                ~

                                   New Member                  Renewal
                                                                          --       10#                                          Annual State/Local          Dues
PERSONAL INFORMATION                                  --                                                                 (Include an e-subscription to the state
NAME                                                                                                                     magazine Texas Woman and local
                                                                                       I

                                                                                                                         Directory and By Laws)
Home Address
                                                                                                                                         +
                                                                                                                         Full Member ($52 $18)   $-
Home (__         )                             Cell Phone (               )                                                                 +
                                                                                                                         Student Member ($15 $18)$__
                                                                                                                         e-Member ($52)                    $-
Email
Birthday (Month/Day)                                                                                                     Name Badge ($10.50):              $-
                                                                                                                         Directory Binder ($5.00)          $-
DEMOGRAPHIC INFORMATION                                                                                                                      Total:        $-
Age Range: 0 18 - 25          026 - 35        036-45         046-55           056-65         066+
                                                                                                                         [J    Check enclosed #__
Highest level of Education Achieved:                                                                                     (payable     to Texas Business Women)

                                                                                                                         [J Credit Card Type:
Occupation:
                                                                                                                         n    MasterCard n VISA
                                                                                                                                 (NoDebitCards)
How did you find out about TBW?            I I Member Referral:
                                                                                                                         #:
J    Newspaper       J   Website    o TBW Event o Other:                                                                 Exp. Date:
                                                                                                                         Name on Card:
BUSINESS INFORMATION (to be listed in the online directory)

Work/Business        Name                                                                                                Signature


Title/Position                                                                                                           Enclose completed       form with
                                                                                                                         payment to:
Address                                                                                                                  Texas Business Women of SA
                                                                                                                         P. O. Box 171164
City                                                              State __       Zip                                     San Antonio,      TX 78217


Business Phone ~)                                          Business Fax ~)                                               If you have questions, please call:

                                                                                                                                     210-497-5559
Web address
                                                                                                                              www.tbwofsa.blogspot.com
0         My company/business        is interested     in offering a discount or special offer to
                                                                                                                          www.texasbusinesswomen.org
          TBW members.         Please have someone contact me to make arrangements.

I prefer to receive email at (check all that apply)                              Home                    Work/Business
                                                                      --                   --
I prefer to receive the local newsletter*       by:                             Mail                     Electronic
                                                                      --                   --
            (Some Locals may choose to mail a newsletter    - the official State Publication Texas Woman is an electronic subscription only)


I am interested in the following      state and/or local committees:             __        Bylaws                                    __    Membership
__     Programs                                   Public Relations                         Foundation                                      Finance
__      Scrapbook
                                         --                                      --                                                  --
                                                                                                                                     __    leadership
                                         __      Fundraising                               MD Anderson
                                                                                 --
__      Scholarship                      __      legislation                     __        Young Women's Connection
        Newsletter                       __       Member Recognition             __        Personal Development
--

                                                                          Local Organization            (if applicable) Texas Business Women of SA
Applicant's Signature

Date                                                                                                                                                      TBW 11-09

				
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