SAWERA Membership Form

SAWERA Membership Form 2004

SAWERA
P.O. Box 91242
Portland, OR 97291-0242

Website: http://www.sawera.org Email: sawera@sawera.org

Would you like to be a part of the solution? Come join an enthusiastic group of people who are making a difference in the lives of women every day! Help us help women in need in Oregon and SW Washington area. Join SAWERA, the circle of strength for women.

__ Yes, I am a woman, 18 years or older, and would like to be a member of SAWERA. Enclosed is my membership fee of $25 for this year.
__ Yes, I am a woman, 18 years or older, and would like to be a patron member. Enclosed is my one-time patron membership fee of $250.

Name:	________________________________________

Address:	________________________________________

Phone:	_______________ E-Mail:__________________

Profession:	________________________________________

Hobbies/Interests:	________________________________________

I would like to volunteer for (select all that apply)
____ Client Advocacy	____ Kids Club	____ Organization Support
____ Grant Writing/Newsletter	____ Fund-Raising	____ Finance/Accounts
____ Other (please specify)

I would like to receive email notices of SAWERA events:__ Yes __ No
I would like my name to be printed as a donor to SAWERA in the Newsletter:__ Yes __ No

The following optional questions help us gather information for grant purposes, as well as help serve our clients better:
Country of Origin: ________________________________
Gender: ________________________________
Languages you Speak: ________________________________

Declaration Of Commitment
As a member of SAWERA, I will support and promote its mission in compliance with the following:
1. I will support all South Asian women in need, irrespective of their religion, nationality, sexual orientation, language or ethnic group.
2. I will respect the confidentiality of victims of domestic violence and other women who seek SAWERA's support/help.

Signature:______________________________ Date:____________________________