WPS of Washington and The Puget Sound

2017 Membership

* required information
Membership Application 
Registration Information
If your spouse is a graduate, please provide their name at graduation, their graduation year and their email address.
Title:
First Name:*
Middle Initial:
Last Name:*
Email:*
Military Rank:
Class Year:
Cullum/Grad #:
Spouse's Name:
Address Line 1:*
Address Line 2:
City:*
State:*
ZIP/Postal Code:*
Home Phone:
Fax:
Employer (if not previously provided):
Position/Title (if not previously provided):
Work Address:
Business Phone:
Business Email:
Please enter the number of years of membership (@ $20 per year + credit card fees):
I understand that bulletins and other correspondence will be sent to my personal email address or to my home address [if I do not have an email address].
$20.00 Annual
Quantity:*
Total Cost: $