_____ I wish to renew my MSWIT membership and am enclosing a payment for $40.
_____ I do not wish to renew my MSWIT membership.Please state reason if possible
(for example - relocating, leave of absence from industry, etc.) ________________________________________________________________________________
Member Name:____________________________ Title:__________________________________
Company:________________________________ # of Years with Company:_________________
Any specialty area as it relates to your company:_______________________________________
Address you would like to use in the directory:__________________________________________
Office phone #:_____________________________ Home phone #:__________________________
Cell phone #:_______________________________ Fax #:_________________________________
Email Address:____________________________________________________________________
Birthday month and day:__________________ Year & month you joined MSWIT:_______________
MSWIT/ office and/or board appointed position held & the year: __________________________________________________________________________________
Please check all positions that you would be interested in:
___President ___Vice President ___Recording Secretary ___Corresponding Secretary
___Treasurer___Director___Alternate Director ___Fundraiser Chair ___Public Relations
___Photographer/Historian___Membership Chair ___Tour & Travel Liaison
___Community Service Liaison ___Website Chair
Please check all committees that you would be interested in volunteering your time for:
____Fundraiser ____Membership Reception ____Community Service
____Activities as they relate to Travel/Conventions sponsored by MSWIT
____I would like to host a monthly meeting at my location and/or provide goods and/or
services for a monthly meeting.
____I would like to donate an item(s) for the annual fundraising auction.
Please list any suggestions/activites/events, etc. that you feel would make our organization
serve the membership/community in a more productive capacity:
________________________________________________________________________________
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Please return this renewal form with payment of $40 no later than December 31 to:
Judy Leblanc
2405 West Pearl Drive, Marrero, LA 70072
New Orleans, LA 70122
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Email
for more information
