Delaware (OH) AAUW Membership Application

(Please Print)

Last Name: _________________________     First Name: _________________________ MI: ___

 

Spouse/Partner Name: _______________________ Maiden Name:_______________________

 

Address: ___________________________________ City: _____________________________

 

Zip Code: ___________________                                 Home Phone: _________________

 

Cell Phone:________________ Email Address: _____________________________________

 

Date of Birth (month/day): ________________

 

College/University: __________________________________________

 

Campus Location:____________________________________________

 

Degree:____________ Year of Graduation: ______________ Major(s):____________________

 

Additional College/University/Degree/Year/Major (s):

____________________________________________________________________

Previous AAUW Membership: Yes: ___   No:___

 

Previous Branch or Member at Large (if Yes): ________________________________________

 

Name used if different than above: _____________________________________

 

Dates of Previous Membership or AAUW Membership Number: __________________________

 

Type Membership (See Annual Dues for type and amounts):______________________________

 

Please print this page and mail completed form w/ check for the appropriate dues made out to “AAUW Delaware, OH Branch” to Finance Officer:

Constance Richards 

4561 Olentangy River Road

Delaware, OH  43015.

If you have other questions, contact Ann Elliot, Membership Chair: annkelliot@gmail.com or 740-369-4057

 

Student Affiliate Applicants Only:

College Attending:_____________________________________ Years Completed:___________