WACE MEMBERSHIP REGISTRATION FORM

PERSONAL INFORMATION
Date:
Honorific:
First Name:
Last Name:
Title:
Organization:
Address:
City:
State/ Province:
Postal/Zip Code:
Country:
Phone:
Fax:
Email:
Website:
MEMBERSHIP INFORMATION
Annual Individual Membership: US $150.00
Annual Organizational Membership: US $ 400.00 (4 people)*
Each Additional Member Under Organizational Membership: US $ 50.00

Type of Membership:
(Select at least one choice from this list. Hold "Ctrl" button and click choices for multiple selections as necessary)
Membership Fee
US$
US$
Additional Membership Name(s):
Total Membership Fees:
US$
Select Payment Option:
   ( To pay by check please see below )
Credit Card # (No Dashes):
Expiration Date:

If Paying by Check Send Registration Form and Payment to:

WACE
c/o Michelle Lennox
WACE Director
World Association for Cooperative Education
360 Huntington Avenue, 384 CP
Boston, Massachusetts  02115-5096

For Membership questions contact Michelle Lennox at (617) 373-8877