WIMS Membership Information Sheet

We ask that you fill out this form if you are an existing WIMS member or wish to become a new member.

For questions or more information, please feel free to contact Samantha Alley (M2) at salley@uthsc.edu.

Personal Information

Preferred Name:

Email Address:

Phone Number (with area code):

College, Program, Grad Year:

I would like to purchase a WIMS t-shirt.      Size:

Payment method:

New Membership Information

I would like to become a WIMS member. I will pay the membership dues
(M1-$40, M2-$30, or M3-$20) via:

Existing Membership Information

I am already a WIMS member. I paid my membership via:

Volunteer Information

Is there a particular area WIMS you have an interest in and would like to be a part of - i.e., event planning, marketing, fundraising, web design etc.

Do you have any ideas for events or programs? (optional)

Do you have any special skills you would like us to know about? (optional)

Please enter the words you see in the box below, in order and separated by a space.
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