****Membership Application for Women’s Consortium****
If you haven’t already joined the Women’s Consortium, or if you need to renew your membership, please
consider doing so today! Membership benefits include reduced conference rates, the newsletter,
membership directory, and access to Shippensburg University Women’s Consortium Announcement list.
One-third of each member’s dues are returned to support women’s activities at that member’s institution.
Membership dates run from 1 September thru 31 August.
FACULTY AND MANAGEMENT
STAFF
1-YEAR membership _____$ 21.00
1-YEAR membership _____$ 9.00
5-YEAR membership _____$100.00
5-YEAR membership _____$40.00
LIFETIME membership _____$300.00
LIFETIME membership _____$150.00
STUDENTS
1-YEAR membership _____$ 3.00
Make check payable to PASSHE Women’s Consortium
Please mail your application and check made out to PASSHE Women’s Consortium to
M. Theresa Bloskey, Chapter President, #268 SSC, Bloomsburg University
DATE __________________________
Name _______________________________________________________________________________
Title ________________________________________________________________________________
Dept./Division ______________________________________________________________________
Campus Address____________________________________________________________________
Institution __________________________________________________________________________
City/State/Zip _____________________________________________________________________
Office Phone _______________________________________________________________________
E-Mail _______________________________________________________________________________
(IF YOU WOULD LIKE TO BE ADDED TO THE WOMEN’S CONSORTIUM ANNOUNCEMENT LIST, PLEASE BE SURE
TO INCLUDE YOUR E-MAIL ADDRESS)
Home Address ______________________________________________________________________
City/State/Zip _____________________________________________________________________