Online Membership Application

Fields marked with an asterisk (*) are required for a successful application.
Memberships are honored between September 2007 and June 2008.

Please check all classifications applicable to you:*
Entrepreneur Service Provider Capital Investor
Student, WPI WPI Employee WPI Alumni - grad. yr.

Name:*
Address:*
City:*
State:*
Zip:*
Company:*
Title:
Phone:*
Fax:

Send e-mail meeting reminders to:

Would you like your information included in our membership directory?*  Yes     No

Select your membership level:*
$50 Annual Membership
Entitles $10 discount admissions to monthly programs, 10 newsletters, email announcements, event discounts.
$125 Discounted Membership ($45 savings)
Entitles free admission to monthly programs, 10 newsletters, email announcements, event discounts
Maintained by webmaster@wpi.edu
Last modified: Sep 10, 2007, 13:44 EDT
[WPI] [Home] [Back]

WPI Venture Forum - 100 Institute Road, Worcester, MA 01609-2280
Phone: +1-508-831-5075 - Fax: +1-508-831-5720 - ventureforum@wpi.edu