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 NameLast Name
Home Address*

Street Address

Street Address Line 2

CityState / Province

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

Area CodePhone Number
Employer (Agency/Division)
Membership Options*

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

YesNo
Are you a spouse of a Veteran?*

YesNo
Interested in volunteering*

Yes! Please send me a list of volunteer opportunitiesNo. 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*

Clear
If on tablet or phone, use your finger to sign, if on computer, use your mouse to sign
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