Membership Form

2016-17 DUES PAYMENT FORM

Dues for New and Renewing members are $65
(National $49, IN State $7, SB Branch $9).

Dues for Paid Life members are $16
(represents State and Branch dues).

Please write check for amount of dues to: AAUW/South Bend Branch.

Mail the check and this membership form to our Treasurer: 
Ann Schroeder, 19191 Burke, South Bend, IN 46637

Name___________________________________________________________

Address__________________________________________________________

Phone:  H____________  W_____________  E-mail________________________

Degrees & Institutions________________________________________________________

Professions/Fields of Study ___________________________________________ 

Amount Enclosed______________

I am a:
_____ new member
_____ renewing member
_____ transferring from a Branch in ____________________