In the Presence of Positive Women Membership Application

Name ________________________________________________________________________

Company Name (if applicable) ________________________________________________

Address _____________________________________________________________________

City _______________________________ State ________________ Zip _____________

Home Phone _______________________ Business Phone ___________________________

Fax___________________________ e-mail________________________________________

 

We never sell our mailing or e-mail list.

  Please circle membership level:  1 Year  2 Year  5 Year

Today’s Date ______________________

Referred by ________________ Amount Enclosed ______________________

Please make checks payable to IPPW and mail to PO Box 3478, Concord, NH 03302-3478