AWIS-PHL Chapter Information Form (Early Career or Full Members)

New Members: Please complete this form AFTER completing your AWIS membership application. This form IS NOT an official membership application. It is for Chapter information purposes only. It will alert the chapter to your new AWIS membership and get you on our e-mail list right away.

In order to join AWIS, proceed first to the National AWIS site and select JOIN AWIS under MEMBERSHIP at the top of the page (or use this link for the AWIS National join page). Do so before completing this form, as you will be asked for your membership number to validate you membership.

Existing Members: You may use this form to update your information at the Chapter level. You may update your information with National AWIS by going to the member log-in section on the AWIS National site.

Only members of both AWIS-PHL and National AWIS are eligible to vote in Chapter and National elections.

This form is safe but not encoded. If you do not wish to fill out the form online, you may print this page and mail or fax your membership information to:
Dr. Ellie Cantor
116 Summit Dr.
Phoenixville, PA 19460
(fax) 888-304-2805

Please fill out all applicable fields as completely as possible.
Fields marked with an * are required.

AWIS-PHL Chapter Information Form

Status *

New Member

Update My Info

Last Name *

First Name *

Middle Name/Initial

Mailing Address

Apt, suite, etc.

Country

City

State

Zip code

Email *

Please provide at least one phone number

Cell Phone

Home Phone

Business Phone

Fax

National Member Number (required to validate your membership status) *

To obtain your membership number, log in to awis.org, select "Member Directory" in the Membership menu, choose "Manage Profile" in the My Profile section, then click on "Membership Card" in the Information and Settings section. You may also contact membership@awisphl.org for assistance with obtaining your membership number.

Employer or Affiliation

Job Title

Highest Degree Attained *

Highest Degree Discipline

Opt-In *

I agree

By completing and submitting this form I acknowledge that I am signing up for the AWIS-PHL mailing list and am providing the requested information voluntarily. I have reviewed and accept the Privacy Policy (see link below).