New Members Membership Form Racine Branch Membership 2020-21 New Member Form Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country College/University - City, State, ZipDegree/YearEmail Home phoneCell phoneOccupation - Place of employmentThe Membership Year runs from July 1 through June 30Option 1: I am paying by check. Make check for $98 or $62 (if qualify for Shape the Future)- payable to 6145 Potomac Place, Mt. Pleasant, WI 53406Option 2: I have (or will) pay my dues online. This will be the full amount of $98.00.Select one option above:Dues for 2020-2021: Shape the Future Optional payments:$59.00$29.50National dues:*State dues:$13.00$6.50Branch dues:$26.00AAUW-Racine Scholarship Fund$98.00$62.00Please indicate your interest in at least one position or committee below. Members are encouraged to serve on at least one committee or participate in one study/ interest group.Arrangements-Book Sale-MembershipProgram-Budget-PhotographerReservations-Publicity-Public PolicyEducation-Study Group Chair-Craft SaleMilestones-Reflections-GEMS: Girls EmpoweredScholarships- Local-Development/Fundraising by Math and ScienceCommunity Issues-Art Fair-Volunteer Opportunities-HistorianNominations Committee-Vice President or other Board PositionStudy and Interest Groups. Check as many groups as you like. Meeting dates and times are published in the Yearbook and highlights.Afternoon Stitchery-Tech TopicsCulture and Cuisine-Practice BridgeBridge Marathon-Great DecisionsLunch and Lit-ADELANTE! Book groupBook and Lunch Bunch-Choral SingersEvening Book and Play-Morning Coffee and Conversation Δ *$56 of your dues is tax deductible as a charitable contribution to AAUW national 501(c)(3). $29.50 is tax deductible if Shape the Future membership.