Workers of America (WoA) Membership Application

Yes, sign me up as a member and bill me. (1 Year - $18.00, 2 Years - $30.00, Lifetime - $175.00)

(Use TAB key to move between fields)

First Name Middle Initial Last Name


City State Zip Code

Optional Information:

E-mail address

Home Phone Fax #

Please check to be sure the information entered above is correct.

or print out this application and mail to:

Workers of America, Inc.

P.O. Box 523028

Springfield, Virginia 22152