Application for Membership

Central Gulf Coast Chapter of the National Weather Association

Payment of first-time dues in the amount of $10.00 ($5.00 for students) makes you a member of the Central Gulf Coast Chapter of the National Weather Association.  Please make a print of the form below and fill out the required information for our records.  Make your check for $10.00 ($5.00 for students) payable to CGCC/NWA and mail along with the form to:

Dr. Keith Blackwell
Dept. of Earth Sciences, University of South Alabama
Mobile, AL  36688-0002

Name: ___________________________________________________________

Telephone: ____________________ (home) ____________________ (business)

Address: _________________________________________________________

              _________________________________________________________

              _________________________________________________________

              _________________________________________________________

E-mail: ____________________________________

Fax: ______________________________________

Business affiliation: (optional) ___________________________________________

I am a national member of the National Weather Association:  (yes) ____  (no) ____


I, __________________________________, agree to abide by the constitution
                   (member signature)
of the Central Gulf Coast Chapter of the National Weather Association.

Receipt for 2001 dues in the amount of $________ from ______________________________
for regular membership in the Central Gulf Coast Chapter of the National Weather Association.

                      ____________Date Paid.  __________Treasurer's Initials