IAWP Membership Application-Check/Agency

Membership Application - Check/Agency Payment

To apply for membership please complete all questions. The asterisk are required
Full Name *

First Name Last Name
Home Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Personal E-mail
Birth Month
Just the month you were born.
Personal Phone

Area Code Phone Number
Employer (Agency/Division)
Membership Options *

Full Workforce Professionals Membership ($84.00/year) Retired Workforce Professionals ($40/year) Young Workforce Professionals (30 years of age or younger) ($50/year)
Are you a Veteran? *

Yes No
Are you a spouse of a Veteran? *

Yes No
Interested in volunteering *

Yes! Please send me a list of volunteer opportunities No. Not at this time.
I learned about IAWP by...
Please put name of person
Payment options *

I am an employee of Employment Security Department, I will be using payroll deduction. ($3.50/a paycheck) Pay by Check (Send checks to PO Box 2543, Olympia, WA 98507)
Signature *

If on tablet or phone, use your finger to sign, if on computer, use your mouse to sign Clear
Signature date *
Publication

From time to time the Washington State Chapter may take photos and videos at chapter events. If you do not want your image used on our website or in publications please check here.
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Membership Application - Check/Agency Payment