AAUW Program in a Box Event Registration Form

[NAME OF EVENT] REGISTRATION FORM Dates of event [insert month, day(s), year] Registration deadline [insert month, day(s), year] Registration fee [insert rates for members, students, guests] Deadline to cancel registration and receive a refund minus a $_____ cancellation fee [insert amount and cancellation deadline month, day, year]

Step One–ATTENDEE INFORMATION Full name ______Preferred name (for badge) ______Address ______City ______State ______Zip code ______Home phone (_____)______Cell phone (_____)______E-mail address ______

The American Association of University Women (AAUW) may use photos taken of me during this event in publications, on AAUW’s website, or in other materials with educational, promotional, editorial, or related purposes. Please check one:  Yes  No  Check here if you require special services. Specify your needs below.

 Check here if you have special dietary restrictions. Specify your needs below.

Step Two–JOIN AAUW TODAY AND SAVE NOW Join AAUW now and take advantage of discounted member rates. Select your membership type and include the cost in step three below. Check www.aauw.org/about/join for current member rates.

 AAUW national member( $)  Student affiliate-at-large ($17) Year of graduation ______Students seeking their first associate or bachelor’s Degree ______degree may join AAUW at this rate. Institution ______Expected graduation year ______Degree ______ AAUW branch member ($) Institution ______Year of graduation ______Degree ______Institution ______Branch ______ AAUW college/university partner member Student enrollment at college or university (Dues are  Less than 1,000 ($125)  1,001 to 5,000 ($175) based on full-time enrollment. Annual membership  5,001 to 10,000 ($250)  10,001 to 20,000 ($275) extends from July 1 to June 30.)  20,001 to 30,000 ($325)  More than 30,000 ($350)

Step Three–PAYMENT Registration Type Registration Fee Membership Fee (if joining) New member $ $ Member $ $ Guest $ $ Student $ $ Total $

 Check or money order (make payable to [insert name])  Credit card [list the types you will accept] Card number ______Expiration date ______Name as it appears on card (print) ______Signature ______Billing address (if different from step one) ______

Send completed form to [insert name, e-mail, address, city, state, zip code].