AJS Women's Caucus Membership Form

Print and mail with your check to:
Caryn Aviv, PhD
Program in Jewish Studies
University of Colorado at Boulder, 122 UCB
Boulder, CO 80302

Please make checks payable to: AJS Women's Caucus

Name ____________________________________________________________
If you are a new member or wish to change any information, please complete the following:

Address__________________________________________________________

________________________________________________________________

City State/Province Zip/Postal Code______________________________________

Country __________________________________________________________

Professional Affiliation ________________________________________________

Telephone _________________________E-mail___________________________

Research interests ___________________________________________________

$______ Dues (check one): Student ($10.00) $______ Faculty ($20.00)


$______ Additional voluntary contribution to the Women's Caucus

$_____ TOTAL PAYMENT

Women's Caucus Breakfast
Monday, Dec. 17, 2012, 7:00 A.M.