Check one: New member        Returning/ renewing member                *Denotes required field

*First name: *Last name:

*Mailing address: Note: this will appear on the Internet 
City: State: Zip:  -       

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

Email address: Most fluent Language:

 Working Languages (In order of proficiency):  (1) 

               (2)        (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

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

Thank you very much!