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Please print, fill out and mail to
Long Island Women's Institute, c/o College of Management C.W. Post Campus, Long Island University Roth Hall 720 Northern Boulevard, Brookville, NY 11548-1300 YES, I would like to join the LONG ISLAND WOMEN'S INSTITUTE. Enclosed please find my membership dues. TYPE OF MEMBERSHIP _______ $25 individual membership _______ $50 organizational, agency or business membership _______ $75 advisory board _______ $250 corporate membership (minimum) YES, In addition to my membership I would like to join one of the committees: COMMITTEES _______ Program and Policy Development _______ Research and Grant Writing _______ Education Please make corporate check payable to: Long Island Women's Institute and send to: Long Island Women's Institute NAME: __________________________________________________________ ADDRESS: _______________________________________________________ _________________________________________________________________ AFFILIATION: ____________________________________________________ TELEPHONE: H (______)________________W (______)_________________ |
| Long Island University | C.W. Post Campus |