NCAWP Membership

NORTH CAROLINA ASSOCIATION OF WORKFORCE PROFESSIONALS
Membership Application 2007

Name_______________________Membership NO:_________________

*Birth Date__________________ *Gender________________________

*Social Security NO:__________________________________________

Street/PO Address___________________________________________

City/State/ZipCode___________________________________________

Is this a new mailing address?________ Yes ____________ No

Telephone:___________________ Fax:__________________________

Email address:_____________________________________

Employer: (Check one): Employment Security
Commission_____Commerce____Community____
Colleges____WorkforceDevelopment____Federal Government____Local
Government____PrivateSector____

Labor____Military____Other____

Agency/Branch/Company/Department/Division/Union_____ Name:________________________________

Central or Local Entity/Office/Unit____ Name:________________________________

   2006 Membership Status:

New_____ Renewal____

Membership Class:    Membership Dues:
Retiree____ $25.00, Includes $4.00 for Chapter Dues
Active_____ $50.00, Includes $8.00 for Chapter Dues

   MAKE CHECK/MONEY ORDER PAYABLE TO:
   NCAWP

SIGNATURE: DATE:
RECRUITED BY:

RETURN THIS COMPLETED

FORM (WITH DUES) TO:
YOUR LOCAL OFFICE CHAIR
OR
THELMA HILL, MEMBERSHIP CHAPTER CHAIR, NCAWP
700 WADE AVENUE, RALEIGH, NC, 27605

2007

NCAWP

The North Carolina Association of Workforce Professionals