| Membership Form Instructions | 
                
                  | 1. Enter your lead agency, today's date, and the name and email of each MAWA member. You can add additional members by clicking +Add Member. | 
                
                  | 2. Dues are $15 per member each year and are an approved WIC expense. | 
                
                  | 3. At the bottom of this form, please enter an email to receive a copy of this form for your records. | 
                
                  | 4. Please complete this form and submit payment to MAWA by April 15, 2025. | 
                
                  | 5. Submit payment to: | 
                
                  | Debbie Hirshberg | 
                
                  | c/o Missoula WIC | 
                
                  | 301 W. Alder St. | 
                
                  | Missoula, MT 59802 |