ASSOCIATE MEMBERS APPLICATION

U.S. Women in Nuclear (WIN) Region IV is composed of women and men that work in Nuclear Power or support nuclear power and encourage the development of world leaders (no matter what age, race, or gender) in the areas of science, engineering, technology and energy. To further encourage you to consider careers in these areas, a free associate membership of WIN Region IV is being opened to kindergarten through 12th grade. However, membership is open to anyone who wishes to join.

This application entitles you to be a member of WINNERS, WIN's- Next Evolutionary Revolutionary Scientists. This on-line membership also entitles you to a membership card received on line, purchase of WINNERS T-Shirts and other on-line items. In addition, educational information is available on-line at www.winregionIV.com website. Information is also found on the website related to annual Save the World Contest, in which only members (Kindergarten through 12th Grade) of WINNERS can participate.

Application Form

- for WINNERS

* All fields needs to be completed.

Email:                 

First Name:        Middle Initial:   

Last Name:        

Home Address: 

City:                    

State:                        Zip Code:  

Home Phone#:  

Cell Phone#:      

School Name:    

School Address:

City:                    

State:                        Zip Code:  

Grade Level:    Kindergarten and 1st Grade
                           2nd and 3rd Grade
                           4th, 5th, and 6th Grade
                           7th, 8th, and 9th Grade
                           10th, 11th, and 12th Grade

                                                                              

home regioniv