Women's Intercultural Network (WIN) Membership Form
   
ANNUAL MEMBERSHIP
Global Circle $100
Friends of WIN $50
Seniors (65 +) $30
Unemployed $25
Student $20 		SPECIAL MEMBERSHIPS
Founders Circle $100
Institutional (universities, non-profits) $150
Patrons (individual, lifetime) $500
Corporate $1000 to $10,000 and up
Angel Donor $5000

 

Individual Member's Name _____________________________________

Organization (if any) __________________________________________

Institution or Company ________________________________________

Address ___________________________________________________

_________________________________________________________

City __________State/Province __________ Zip/Postal Code __________ Country __________

Telephone __________ Fax __________ Email Address ____________________

Cash Enclosed $ __________Check payable to WIN $__________________

To Pay by Credit Card $_______

Cardholder's Name____________________

Expiration Date_______ MasterCard/Visa (circle one)Card #_____________

Cardholder's Signature___________________________________________

Mail your tax deductible donation to: WIN, 1950 Hayes St. #2, San Francisco, CA 94117 USA
or download and fax your credit card information to 915-200-5074, WIN Tax ID #94-32004314
For information: Phone 415-221-4841, e-mail: win@win-cawa.org