This information will be published in the branch newsletter as an introduction.

Name __________________________________ Email ______________________________ Date _________________

Address __________________________________________________________________   Zip ___________________

Home phone _________________________________  Cell phone___________________________________________

Birth Date (not the year) __________________ 

Spouse’s name (optional): __________________________________

Please list academic degree(s) (i.e. AA, BA, BS, MS, PhD, other) with date received and the name of school(s):

(1) Name of Institution: ___________________________

City/State: _______________________________ Degree Conferred:   _________________

Field of Study: ___________________________ Year Conferred:       ________________

(2) Name of Institution:____________________________

City/State: ________________________________  Degree Conferred:  __________________

Field of Study: ____________________________    Year Conferred:      __________________                                                                                  

(3) Name of Institution:____________________________

City/State: ________________________________  Degree Conferred: _________________

Field of Study: ____________________________Year Conferred:      __________________  

Professional employment; indicate if retired:

________________________________________________________

Volunteer Work: ________________________________________________________________________________    

Membership in other organizations: _______________________________________________________________

Are you a prior AAUW Member?   Where and when? _________________________________________________

Who and/or what attracted you to AAUW?  __________________________________________________________________________________

__________________________________________________________________________________

How would you like to receive the newsletter?  Check one:    Email .doc ___  .pdf ___   Postal mail ___

(Email is strongly encouraged as it saves approximately $1.00 in printing and postage each newsletter!!!)

We have many interest groups & committees.  Indicate those of interest to you, so we might act to get you involved. Circle ALL of interest to you:  Arts & Entertainment, Dining & Food, Hiking, History, Literature, Politics,                               Technology, and Travel.   Write-in your additional interests: _____________________________________________

Circle the committee(s) on which you might like to serve: Community, Fundraising, Hospitality, Membership, Program, Public Policy, Publicity, and Scholarship

Please return this form and your $80 check, made payable to AAUW, to:

Joan Capesius, 352 Blue Windsor Lane, Colorado Springs, CO 80906

Questions?  Email joankcap@comcast.net or call 719-576-2621