Membership Form

NWPC - Metro St. Louis

Date:                                

Name:                                                                                     

Address:                                                                                   

City:                                                  State:          ZIP:                  

Home Phone:                                     

E-mail:                                                                                

Work Phone                                Fax:                            

Occupation:                                                                         

Please check one of the following:    New Member   Renewal

$                      Governing Member ($60)  Annual membership dues includes full voting membership in local, state and national organization.  Entitles you to receive local and state newsletters, and the national publication, the Women's Political Times.  (A student/limited income rate is available upon request.) 

$                      I want to do more and am sending an additional contribution to help the NWPC - Metro St. Louis achieve its goals. (contributions are not tax deductible)

$                      TOTAL AMOUNT ENCLOSED

Print and complete this form and mail with a check to:

NWPC - Metro St. Louis
PO Box 11365, St. Louis, MO 63105