INTERNATIONAL ASSOCIATION OF WORKFORCE PROFESSIONALS

SOUTH DAKOTA CHAPTER MEMBER REGISTRATION FORM

Last Name First MI

Mailing Address

City State Zip

Telephone Fax Email Address

Place of Employment Date of Application

*The following is optional and for identification purposes only.*

*Birth Date

Check One:
($62.00) ($31.00)

Check One:




Check One:



(Please complete credit card info at bottom of this form.)

Print and Mail completed form and payment, (do not mail cash) to:
IAWP Membership Chair
420 Roosevelt Avenue
PO Box 4730
Aberdeen, SD 57402-4730

Card Number:
Expiration Date:

I hereby authorize the IAWP International to charge the credit card specified above for my IAWP dues (chapter and International portions)in the membership year shown above. I under-stand that the chapter portion of my dues will be returned to my chapter.

Signature_____________________________

Date________________________________