AJS Women's Caucus Membership Form

Print and mail with your check to:
Andrea Lieber
Department of Religion
Dickinson College
P.O. Box 1773
Carlisle, PA 17013

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 ($5.00) $______ Faculty ($20.00)


$______ Additional voluntary contribution to the Women's Caucus

$_____ TOTAL PAYMENT

Women's Caucus Breakfast
Monday, Dec. 17, 2007, 7:00 A.M.

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