Arkansas Business & Professional Women

Membership Form

Instructions:  Please print.  Please fill out all applicable information to help us keep our records up-to-date. 

We ask that you notify the State Treasurer of any changes during the year.  Check-mark the “circles” that apply to you.

Make three copies and distribute to LO President, State Treasurer and State Data Base Administrator (see below).

Name:                                                                                                                                                                                     

Local Organization (LO):                                                                                                                                                      

Region (leave blank if you do not know):                                                                                                                                

Home Information:

Address:                                                                                                                                                                                  

                                                                                                                                                                                                 

Phone:                                                    Cell:                                                      Fax:                                                               

E-Mail:                                                                                                                                                                                   

Work Information:

Employer:                                                                                                                                                                               

Address:                                                                                                                                                                                  

                                                                                                                                                                                                 

Phone:                                                    Cell:                                                      Fax:                                                               

E-Mail:                                                                                                                                                                                   

-Add me to the AR/BPW ListServe at my:                        ○m  Home E-Mail              m○ Work E-Mail

-Send my Quarterly Issue of the ABW to my:                  ○m  Home Address             m○ Work Address

OR

                                              Via E-mail to my:                 ○m  Home E-Mail              ○m  Work E-Mail

-I am interested in and would be willing to serve:

○Arkansas Business Woman (ABW)                                        m      ○Regional Committee

○Individual Development (ID)                                               m      ○Women Joining Forces

○National Business Women’s Week (NBWW)                         m      ○Young Careerist (YC)

○Pay Equity Day

-I want to serve on committees of my:                       m○ LO             m○ Region                m○ State

-I plan to attend (dates to be announced via ABW Magazine, ListServe, and LO):

○Mid-Year Board (MYB)                                                 m      ○Annual Women Mean Business Gala

○Issues Management (IM)                                                m      ○Annual State Convention

○Lobby Day                                                                   m      ○Policy in Action (in Washington, D.C.)

                                                                                                                                                                                                  

Pay by:  m  Check   or   m  Credit Card (Visa or Mastercard only)

Credit Card No.:                                                                                                                                                                         

Name on Card                                                                                                                                                                            

Expiration Date:                                                                    Authorization Code (3-digit code on back of card):                              

Billing Address/City/State/Zip:                                                                                                                                                      

                                                                                                                                                                                                   

Billing Phone Number:                                                                                                                                                                

 

Please e-mail completed form to your Local President

State Treasurer Donna Hopkins

Website admin Hermine Linz

 

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