Member of California BPW/USA

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Personal Information:

Name:

Company name:

Work Address:

City, State, Zip (please include +4):

Home Address:

City, State, Zip:

Please Indicate your preferred mailing address: Home    Work

Home Phone:    Work Phone:

Fax:         E-mail:

Please join us today as a BPW/Verdugo Hills Member!

To become a member, return this form, along with your annual dues, to:

1) Mail your payment to:

BPW/Verdugo Hills Membership

Attn: Judee Carrico

P.O. Box 4005

Glendale, CA 91222-0005

 

Professional Information:

Type of Employer:

Government      Educational

Professional Services   Health Facility/Med. Ctr.

Finance/Insurance    Retail Service

Retail Trade      Construction/Real Estate

Assoc./Non-Profit      Other

Communications        Self Employed

Manufacturing

Workplace Profile; Number of Employees:

1-10    11-50      51-100    101-500     over 500

If a BPW/USA Member assisted you in learning more about our organization, please list her/his

name here so we may thank her/him:

Name/Member ID (if known)