50th Anniversary Virtual Celebration Registration Form

Attendee Name: *

First Name Last Name

Address *

Street Address

Street Address Line 2

City State

Zip Code

Phone Number *

Area Code Phone Number

E-mail *

League Name

Check all that apply to you

Current National Officer Current National Officer and Current or Past Top Ten Past National Officer and Current or Past Top Ten Current 2021 Top Ten Past Top Ten Past National Women's Leadership Conference Chair

If you selected "Current National Officer" above, please indicate your title:

National Officer Title

If you selected "Past National Officer" above, please indicate the highest national office you held and the year if you were a NWLC Chair :

Maryland Capital Members Only

Check all that apply to you

Current Chapter Officer or Committee Chair Past Chapter President Current or Past Woman of the Year Past Top Ten Past Top Ten Nominee Current or Past Protege

If you selected "Past Chapter President", Past WOY, Past Top Ten Nominee, or Past Protege above, please indicate the year:

If submitting payment via check or money order, please click the "Print Form" button and mail it with your check or money order payable to "ABWA - MD Capital Chapter" in the amount of $25.00 no later than March 19, 2021 to:

ABWA - MD Capital Chapter
P.O. Box 1955
Edgewater, Maryland 21037

Once payment is received, you will receive an email confirmation informing you that your registration is complete and the Zoom link will be forwarded.

If paying by credit card, click "Submit Form" to be taken to the payment page. You may need to disable your pop-up blocker to continue. The Zoom link will be in your email confirmation.