1. 2017 Membership Dues
January 1, 2017 to December 31, 2017
Yes, I intend to continue/begin involvement and participation in
the Western New York Employment Consortium.
Date:___________________________
Name:_____________________________________________________
Title:_______________________________________________________
Agency:____________________________________________________
Address:___________________________________________________
City:_____________________________________Zip:_______________
Telephone:_______________________________Extension:__________
Email:__________________________________Fax:_________________
Amount Enclosed: $_____________ New Member(Y) (N) (Circle One)
Make Checks in the amountof $50.00 per memberto:
WNY EMPLOYMENT CONSORTIUM
Mail Checksto: WNY EmploymentConsortium
C/O People Inc
ATTN: Tina Polito
4286 Delaware Ave, Tonawanda,NY 14150
(716) 694-6630 | tpolito@people-inc.org