The Women's Alliance Membership Application (US Employees Only)

Eligibility All salaried exempt / non-exempt women employees of Xerox and its wholly owned subsidiaries.
Annual Dues $36 US, non-refundable. Initial dues are payable by check for the current year or by monthly payroll deduction for a continuous membership period.

Please fill in the fields below, even for a renewal.
8*
First Name Last Name Xerox Mail Stop Intelnet No. ORG (I.E., USSG, PSG)
 
Current Job Title

Internet Email Address Office City Location
PAYROLL DEDUCTION:

TWA membership is paid through payroll deduction. Please complete the following fields:.

Employee #

Pay Method: Xerox Employee Weekly Semi-Monthly Monthly
XFCU Employee Weekly Semi-Monthly Monthly


I authorize Xerox Payroll to deduct $3.00 from my paycheck each month for The Women's Alliance. The deduction will show as code M06. The deduction will occur the first pay period of the month for all paycheck frequencies. The deduction will begin the month after TWA Membership (Renée Bates) receives this form and will continue until I authorize The Women's Alliance to stop my deduction.

 





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