Thank you for taking the time to update your contact
information with us.
Personal Information
Salutation:
First Name:
Last Name:
Address:
Address line 2:
City:
State:
Zip:
Country:
Phone:
(include area code)
E-mail:
Work Information
Current Employer:
Job Title:
Work Telephone:
(include area code)
Work Fax:
(include area code)
Relationship to SPUSA
What's your link to Student Pugwash USA?
Former student participant
Current student participant
Faculty
Professional colleague
Other (describe below)
Supporting SPUSA
How can you support Student Pugwash USA in 2007?
YES! I want to offer financial support for Student Pugwash's programs and activities! (You will have the opportunity to donate after submitting your contact information.)
YES! I want to learn more about volunteering with Student Pugwash programs in my area!
YES! I want to offer my professional services to Student Pugwash!
