Sign up to join the Middlesex United Way Women's Initiative! Annual Dues are $35 and can be paid online or by check. Please fill out the form below. Information will be used for the Women's Initiative directory. First name: * Last name: * Name to appear on Badge (if different than above) Email: * Address: * City, State Zip * Phone number: * Employer: * Occupation/Job title: * Birthday (Date): * - Select -01020304050607080910111213141516171819202122232425262728293031 Birthday (Month): * - Select -010203040506070809101112 Please check all that apply: I would like to serve on the Fund Distribution subcommittee. I would like to serve on the Special Events subcommittee. I would like to serve on the New Membership Recruitment subcommittee. Please select one: * Yes, I would like my name included in the WI Directory. I understand this will not be published on any website, social media or public electronic forum and will only be available to members as print versions for personal/business networking purposes. No, I would not like my name included in the WI Directory. Are you a new member? * Yes No Leave this field blank CAPTCHAThis question is for testing whether you are a human visitor and to prevent automated spam submissions.