[Power 4 Women]
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To register, print the registration form, complete the form offline, and mail the form with your payment to:
Power for Women
28 East Jackson Blvd., #1900
Chicago, IL 60604-2211.
YES! I want to register.

Name: _______________________________

Address: _______________________________


City: __________________________________

State/Zip Code: ___________________________

Phone - Day (_____)_______________

Phone - Night (_____)_______________

e-mail: _________________________________


Payment:


Associate membership Number of Members: _____
at $20 each
Please give us names and addresses.


$_________
Donation to
the Scholarship Fund

$_________

Grand Total

$_________



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E-Mail Us: powerforwomen@hotmail.com