Corporate Sponsor Form

YES, I would like to join the Long Island Women’s Institute.
Enclosed please find my membership/Corporate contribution:
Type of Membership
$300 corporate membership*
$75 advisory board
$50 organizational membership
$35 individual membership
*allows you to sponsor a conference/seminar/workshop

Name: ______________________________________________________

Address: ____________________________________________________

____________________________________________________________

____________________________________________________________
(Name of company if corporate membership)

Affiliation: ___________________________________________________

Telephone Number:
(Home) ______________________________________________________
(Work) ______________________________________________________

E-mail Address: ______________________________________________

Please make check payable to:
LIU/Long Island Women’s Institute

And mail to:
Long Island Women’s Institute
c/o College of Management
C.W. Post Campus
Long Island University
Roth Hall
720 Northern Blvd.
Brookville, NY 11548-1400
(516) 299-3146