EWB-UIC member registration form

Academic year 2007-2008

Application

First Name
Middle Name
Last Name
Gender
Birth date

Status
Major (if applicable)
Expected graduation date (if applicable)

Street

City
State
ZIP

Phone
Email

By submitting this form, I agree to pay the $15 membership fee for the academic year 2007-2008 to EWB-UIC. Membership includes EWB-UIC chapter affiliation, as well as EWB-USA national membership.

The membership fee will be collected by the EWB-UIC treasurer (treasurer@ewb-uic.org). Payments can be made by either cash or check. Make checks payable to EWB-UIC. The membership will become effective only after the fee has been paid.