PNCWA Membership Form

New Member Renewal

Name

Address

City

State Zip

Phone (Home)

Phone (Work)

Email

I will send a check for $15 made payable to PNCWA.
(Dues are from July 1 to June 30 and must be paid in order to participate
in general Association or Interest Group activities).

I also wish to include an additional donation to support programming, curriculum, or scholarships at PNC. Donation Amount ($):

Interest Groups I am interested in and/or New Interest Groups I would like to start (please describe):

I am a newcomer to the area. Please contact me regarding the Newcomer's Group.

Comments:

Please hit "Submit" and then send your check to:
Maria Watson, Membership
Purdue North Central Women's Association
1401 S. US 421, Westville, IN 46391