MEMBERSHIP

STATUS:

NEW RETURNING

MEMBER AS OF: _________________

QUARTER / YEAR

YOUR NAME

LAST_____________________________________________________________________________________

FIRST ______________________________________________________ MIDDLE ______________________

DATE OF BIRTH __________________________

PHONE #: (
) _______ - ______________

MONTH/DAY/YEAR

EMAIL ADDRESS ____________________________________________________________________________

EDUCATIONAL BACKGROUND

MAJOR _______________________________________________ CLASS _____________________

FRESHMAN/SOPHMORE/JUNIOR/SENIOR/SUPERSENIOR

INTRAMURAL SPORTS INTERESTED IN:

Flag Football

Tennis

Basketball

Volleyball

Soccer

COMMITTEES INTERESTED IN:

Int Projects (Chaguite, Nicaragua Project Team)

Local Projects (Pump House Project Team)

Outreach Events

Spring Gala

HOW DID YOU HEAR ABOUT EWB? _________________________________________________________

______________________________________________________________________________________
INTEREST ______________________________________________________________________________
______________________________________________________________________________________

PAYMENT METHOD MEMBERSHIP FEE IS $20.00 (INCLUDES FREE T-SHIRT) THEN $25 AFTER 2

ND

MEETING OF THE QUARTER

CASH



SIGNATURE:

CHECK

T-SHIRT SIZE:

SMALL

MEDIUM

DATE:

LARGE

X-LARGE