Washington Map Society Membership Census Form

Please printout this form on your printer.
This form is purely optional. Information in question 4 is requested to better understand the interests of members of the Washington Map Society, as well as to publish these interests in the Membership Directory. If requested below, the information will not be included in the Directory. Age range (question 3) will not be published.

If you have submitted this form before but your interests have changed, you may use this form to update parts that have changed.

1. Name ________________________________________________________________________

2. How did you first learn about WMS?______________________________________________________

3. Age: Less than 30 ____ Between 30-39____ 40-49____ 50-59____ 60-69____ 70+____

4. What are your cartographic interests? OK to publish interests in Directory? __Y __N

Geographic Areas of Interest_________________________________________________________________

________________________________________________________________________________________

Topical Areas of Interest____________________________________________________________________

________________________________________________________________________________________

5. Are you are interested in helping with the work of the Society?
If so, in what capacity?

___ Featured speaker at meeting (topics?) _________________________________________________________

___ Write Portolan article (topics?) ______________________________________________________________

___ Book Reviewer in listed areas of cartographic interest

___ Officer/Board Member (Any particular jobs?) ___________________________________________________

___ Help With Portolan/Ristow Prize/Membership/Other Work

___ Other (Please identify) _____________________________________________________________________

6. If you belong to other map societies or groups of similar interest, please list.

____________________________________________________________________________________________

Thank you for your participation!

Please send form to John W. Docktor, 3100 N Highway A1A PHA1, Fort Pierce FL 34949-8831, USA.