EmailMeForm
USWT Intent to Follow Up
Complete this form and send to your State Membership Vice President with the charter fee.
This form requires the signature of the Chapter President or Extension Chair; be sure that one of them are present when completing it. Signatures can be done by your mouse, or your finger on a writable screen.
Responses to the online form will be viewed by the USWT Extension Director, and your state contact. Fill in as much information as you know. Upon completion of the form, click Submit; you will receive a confirmation screen if your form has been successfully submitted. (rev 2019)
Your Email
*
Submitter Name
*
First
Last
Phone
###
-
###
-
####
Address
Street Address
City
State / Province / Region
Postal / Zip Code
Date Submitted
*
MM
/
DD
/
YYYY
State
*
Please select
Arizona
Illinois
Iowa
Massachusetts
Minnesota
Missouri
Nebraska
New Jersey
North Dakota
Oklahoma
Pennsylvania
South Dakota
Wisconsin
Cyprus
Other
Other State
*
If you are a member of a state organization not listed, please enter your state.
Chapter
*
Chapter President Name
*
First
Last
Extension Chair Name
*
First
Last
Signature
*
Clear
I hereby attest that the extending chapter of the Women of Today expresses their intent to continue the "follow up" through orientations, guidance, support, and encouragement to help this new extension become a strong member of the Women of Today.
