Central Illinois Women's Bar Association
June 1, 2019-May 31, 2020 Membership Form
Name *
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Company/Firm Name *
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Address, City, State, Zip Code *
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Phone Number *
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E-mail *
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Areas of Practice
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ARDC number *
Your answer
Please mark the committee(s) you are interested in serving on:
Membership Type *
Dues are due by June 1, 2019 *
Please make checks payable to Central Illinois Women's Bar Association or CIWBA. Please submit payment to Maureen Faller, Prairie State Bank and Trust, 3751 West Wabash, Springfield, IL 62711. **Late fee of $5.00 after July 1, 2019. Late fee of $10.00 after August 1, 2019. Late fee does not apply to first time members. ** By dating and submitting this form, I certify that I have remitted payment of dues to CIWBA.
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