Sigma Delta Epsilon
Graduate Women in Science
Membership Form
Complete the form below, print it, then send it to the address below.
(Or print pdf form, fill in by hand and send to the same address)
(Return to Membership page)

Date of Application:

First Name: Last Name: Middle Name:

Preferred Mailing Address: Choose from list... home work Home Address:

Home Phone:

Employer:

Work Address:

Work Phone: Fax:

Email Address:

Academic Achievements:

BA/BS year received:

Occupation:

MA/MS year received or expected:

Published Paper (Title), Research Experience, or Project:

PhD year received or expected:

MD year received or expected:

Member Status	National Dues Category
Choose one from list... new renewal	Choose one from list... Regular ($60) Graduate Student ($25) Emeritus ($25) Affiliate - undergrad or k-12 teacher ($10) Life Membership ($600, or $100/yr for 6 years) Omega Chapter Dues ($15)
Chapter Dues Category: Choose one from list... Alpha ($0 - inactive) Alpha Lambda (no info - contact chapter) Alpha Omega - standard ($10) Alpha Omega - grad student or emeritus ($5) Beta - standard ($20) Beta - grad student ($10) Kappa - standard ($10) Kappa - grad student ($5) MSU (no info - contact chapter) Nu ($10) Omega (no info - contact chapter) Omicron ($20) Psi ($10) Sigma - standard ($10) Sigma - grad student ($5) Tau - standard ($25) Tau - grad student or emeritus ($15) Xi - standard ($20) Xi - undergrad ($10)
Check sent for: $ Print page and send to address below:
Make check payable to SDE/GWIS and mail to: Sharon E. Altmann, GWIS Membership Secretary PO Box 5494 Madison, WI 53705-0494