Online Membership Form - Berks County Commission for Women

First Name
Last Name
Address
City
State
Zip Code
Home Phone
Work Phone * (Optional)
Fax * (Optional)
Email Address
Occupation/Vocation/ Business
Volunteer Experience (if any) * (Optional)

Before submitting online, please print out a copy
of this form to accompany your check

Dues are $25.00 per year, payable to:
BERKS COUNTY COMMISSION FOR WOMEN
P.O. BOX 12225
READING, PA. 19612