New Mexico Network for Women in Science and Engineering

PO Box 51926, Albuquerque, NM 87181

NMNWSE_Board-L@list.unm.edu

http://nmnwse.org

Membership Form

Membership year October 1 through September 30 (or fall elections, whichever is later)

Print, fill in, and mail completed form and your dues to NMNWSE at the address at top.

Full Name:

 

Date:

 

This form is for:

I am enclosing:

 

Membership Renewal

 

$40 Professional

 

Information Change

 

$10 Student / Teacher / Retired / Non-employed

 

New Membership

 

$ Donation* for ____general fund ____student awards

 

 

 

____EYH scholarships@$10/student ____EYH (gen)
____other (specify):

Contact Information:

*Donations to NMNWSE are tax deductible to the full extent of the law. Membership
fees are not. If you need a receipt for tax purposes, please check here:______

Occupation:

 

Employer:

 

Work Address:

 

 

 

Home Address:

 

 

 

E-mail Address(es):

 

Telephones: day:

 

evening:

 

cell:

 

fax:

 

Preferred Newsletter option:

email:

 

mail:

 

 

Education:

School:

 

Maj:

 

Deg:

 

Yr:

 

School:

 

Maj:

 

Deg:

 

Yr:

 

School:

 

Maj:

 

Deg:

 

Yr:

 

Indicate your interests. Please mark area to appear in the membership directory by 'MD', additional interests by 'X'.

 

Anthropology

 

Chemistry

 

Geology

 

Medical Sciences

 

Astronomy

 

Computers

 

Health Sciences

 

Physics

 

Biology

 

Education

 

Management

 

Psychology

 

Business

 

Engineering

 

Mathematics

 

other (specify):

 

 

 

 

 

Indicate the local chapter with which you wish to be affiliated:

 

Central (Albuquerque Area)

 

Northern (Los Alamos and Santa Fe Area)

 

Eastern (Portales Area)

 

Southern (Las Cruces and Silver City Area)



NMNWSE Membership Preferences (optional)

Indicate NMNWSE outreach and activities that interest you:

Outreach - Expanding Your Horizons (EYH), Student Awards, etc:

 

EYH All

 

EYH Silver City

 

EYH Los Alamos

 

EYH Las Cruces

 

EYH Santa Fe

 

EYH Carlsbad

 

EYH Albuquerque

 

new EYH in

 

 

Science Fair/Student Awards

 

judging awards

 

National Girls Collaborative Project

 

 

 

Improving NMNWSE Careers book

 

updating related links on website

 

Other outreach (specify):

 

Annual and Local Meetings:

 

Annual Meeting attendance

 

Annual Meeting planning

 

Annual Technical Presentations

 

 

 

Local Meetings with networking

 

Local Meetings with talks

Board Activities (BA):

 

BA Website

 

BA Fundraising

 

BA Publicity

 

BA Newsletter

 

BA Archives

 

BA at-large

 

BA Membership

 

BA IMPACT! award

 

BA local board

 

BA other (specify):

 

 

Indicate the listserver(s) you'd like to be on: (members automatically added to NMNWSE-L)

 

NMNWSE_Board (board members automatically added)

 

LAWIS (Northern Chapter)

 

Central Chapter (Central Chapter Activies)

 

Central_EYH (EYH Albuquerque)

Email(s) to add to list server(s):

 

home

 

work

 

other (specify):

 

If you have alternate emails you'd like to be able to post from, but do not want subscribed, please list them below
(otherwise posts from non-subscribed emails bounce to the webmaster for approval, a spam control measure):

 

Internal Use

Action

Date

dues

received

 

database

change rec'd

 

database

changed

 

sent to

local president

 

Membership Year

 

Last

Paid

 

What would you like to get back from NMNWSE membership?

 
 

Other Comments?