First Name

Last Name

Email for program invitations, upcoming activities, and newsletters.

Phone ex: xxx-xxx-xxxx

Address

City

State Please select... AL AK AZ AR CA CO CT DC DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY AS FM GU MH MP PW PR VI AE AA AP Other

Zip Code

Release My Name Please select... Yes No

Release My Email Please select... Yes No

Release My Phone Please select... Yes No

Type Please select... Newcomer Renewing Member

Eligibility Please select... Female faculty and staff Female spouses and widows of faculty and staff - current or retired Female retiree Female visiting faculty and female spouses of visiting faculty

Baylor Employee Name(connected to your membership)

Baylor Department(connected to your membership)

Committee Preference #1 Please select... Any Committee Anniversary Committee Budget Committee Chaplain Committee Christmas Committee Interest Group Committee International Dinner Committee Membership Committee Newcomers Committee Program Committee Public Relations Committee Scholarship Committee Style Show Committee

Committee Preference #2 Please select... Any Committee Anniversary Committee Budget Committee Chaplain Committee Christmas Committee Interest Group Committee International Dinner Committee Membership Committee Newcomers Committee Program Committee Public Relations Committee Scholarship Committee Style Show Committee

Assist with Providing Refreshments Please select... Yes No

Would you like to make a donation to the Baylor Round Table scholarship fund? Please select... Yes No

Amount of Donation Valid number, please. Do not include a dollar sign.

Payment Type Please select... Credit Card Check