New Mexico Network for Women in Science and Engineering Membership Application
Membership year October 1 through September 30 (or fall elections, whichever is later)
Name
*
First Name
Last Name
Date
*
-
Month
-
Day
Year
Date
This Application is For:
*
Membership Renewal
New Membership
Information Change / Other
Membership Fees
*
$40 Professional
$10 Student / Teacher / Retired / Non-Employed
Contact Information
Occupation
*
Employer
*
Work Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Best Phone Number to Reach You
*
Please enter a valid phone number.
Back
Next
Education
School:
*
Major:
*
Degree:
*
Year:
*
School 2:
*
Major:
*
Degree:
*
Year:
*
School 3:
Major:
Degree:
Year:
Indicate Your Interests
*
Anthropology
Astronomy
Biology
Business
Chemistry
Computers
Education
Engineering
Geology
Health Sciences
Management
Mathematics
Medical Sciences
Physics
Psychology
Other
If Other, Please 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)
Back
Next
Indicate the NMNWSE Outreach and Activities That Interest You: Outreach - Expanding Your Horizons (EYH), Student Awards, etc:
*
EYH ALL
EYH Los Alamos
EYH Santa Fe
EYH Silver City
EYH Las Cruces
EYH Carlsbad
Science Fair / Student Awards
National Girls Collaborative Project
Improving NMNWSE Careers Book
Judging Awards
Updating Related Links on Website
Other Outreach
If Other Outreach, Please Specify:
Annual and Local Meetings
*
Annual Meeting Attendance
Annual Technical Presentations
Local Meetings With Networking
Annual Meeting Planning
Local Meetings with Talks
Board Activities (BA)
*
BA Website
BA Newsletter
BA Membership
BA Fundraising
BA Archives
BA !IMPACT Award
BA Publicity
BA At-Large
BA Local Board
BA Other
If BA Other, Please Specify
Indicate the Listserver(s) You Would Like To Be On: (members automatically added to NMNWSE-L)
*
NMNWSE_Board (Board Members Automatically Added)
Central Chapter (Central Chapter Activities)
LAWIS (Northern Chapter)
Central_EYE (EYH Albuquerque)
E-Mail(s) to add to list server(s)
Home
Work
Other
Home Email
example@example.com
Work Email
example@example.com
Other Email
example@example.com
If you have alternative emails you would like to be able to post from, but do not want subscribed, please list them here: (Otherwise posts from non-subscribed emails bounce to the webmaster for approval, a spam control measure)
What What You Like To Get From NMNWSE Membership?
*
Other Comments:
Submit
Should be Empty: