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Membership Form

Name _________________________

Department/Division _____________________ Phone ________

Email ____________________________________

___ Member (faculty/other professional category) ___ Associate Member

Returning and Associate Members - $15.00 annually.

Make checks payable to Cal Poly Pomona Foundation.

___ I am interested in serving on the WFA Advisory Board.

New on campus?

Membership is complimentary for your first year. Please complete the following.

_____ I am interested in having a WFA mentor assigned to me.

I understand the selection will be a collaborative process. I am aware that mentoring entails regular meetings and other responsibility on my part. I would like my mentor to be (check one):

___ In my department ____In my college ____ In administration ___ No preference

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