AWIS-PHL Chapter Information Form

New Members: Please complete this form in addition to the AWIS National membership application so that we can get you onto our chapter rolls more quickly. This form IS NOT an official membership application. It is for Chapter information puposes only. It will alert the chapter to your new membership and get you on our e-mail list right away. Once you complete your Chapter Information Form, you MUST proceed to the National AWIS site and click on "Join AIWS" in the upper right corner to complete the membership process.

Existing Members: Please use this form to update your information.

Only members of both AWIS-PHL and National AWIS are eligible to vote in Chapter and National elections.

If you do not wish to fill out the form online, you may print this page and mail or fax your membership information to:

    Dr. Edyth Malin
    648 Vassar Road
    Strafford, PA 19087-5313

    (fax) 888-304-2805

Or you may e-mail your information to: membership@awisphl.org.

Please fill out all applicable fields as completely as possible.

Fields marked with * are required.

Date Member Update
Salutation/Greeting Mr. Mrs. Ms. Dr. Prof.
Last name *
First name *
Middle name/Initial
Mailing address *
City *
State *
ZIP *
Work phone
Home phone
Fax
Email address
National Member Number (if known)
Affiliation or Employer
Employment Status Full-time Part-time Student
PostDoc Retired Other
Highest Degree
Highest Degree Discipline