The following form will be used to gather information to process your membership application. Privacy policy: EERS does not sell its membership directory; all member information is for internal use only.
In order to become a member, please print this form, complete it, and mail it with a check or money order payable to EERS to:
EERS
c/o Celeste Anderson
513 Wyndham Road
Wilmington, DE 19809
Please circle one membership category:
Regular - $35/year - Includes all member benefits
Student - $10/year - Attach proof of student status
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| First Name, Middle Initial: |
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| E-mail Address (required): |
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| Employer/School/Professional Affiliation: |
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| Street Address: |
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| City: |
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| State: |
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| Zip Code: |
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| Business Telephone: |
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| Home Telephone (optional) |
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| Fax Number |
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