*First name: *Last name:

*Mailing address:
City: State: Zip:  -

Work phone:          Home phone:  
Fax: Pager: Cell phone:

Email address: Most fluent Language:

 Working Languages (In order of proficiency):

(1)                   (4) 
(2)                   (5) 
(3)  

Please indicate the WITS Committee(s) in which you would like to participate:

Programs and Education	Grievances
Membership	Outreach/ Public Relations
Newsletter & Publications	Regional Liaison
Nominations/ Elections	Advocacy

*Denotes required field  

NOTE: We must receive payment to activate your membership.

Joint with NOTIS: $70 ($10 savings)

Individual: $45.00         

Supporting: $50.00

Full-time student: $15.00

Institutional/Corporate: $90.00

Print out form, sign & mail with payment (checks in US funds payable to WITS) to:

WITS
PO Box 1012 
Seattle, WA  98111-1012