GAWHE Membership Application

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Name Title First Last Suffix
Title
Department/Division/Unit
Institution
Address
Street Address

Address Line 2

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Work Telephone - (###) - ### ####
Fax - (###) - ### ####
Email
Highest Degree level
Field of Study
Expertise/Skills

List areas of expertise and skills you are willing to share with other members
Annual Membership Dues, check one: New Member Renewal
Annual dues are $30 (January - December). If paying by check, please make payable to GAWHE and mail to one of the following: GAWHE c/o Dr. Angela Evans, co-VP for Membership & Outreach Kennesaw State University 3391 Town Point Drive Campus Box 9111 Kennesaw, GA 30144-5591 aevans@kennesaw.edu FAX: 470-578-9169 GAWHE c/o Dr. Margaret Venable, co-VP for Membership & Outreach Dalton State College 150 Westcott Admin. Bldg. 650 College Drive Dalton, GA 30720 mvenable@daltonstate.edu **Annual dues may also be paid by credit card at www.gawhe.org **Please note: If paying by credit card, you must also fax or email this membership application to one of the co-Vice Presidents for Membership and Outreach so that we will have your complete information on file.**