PAWA Application Form

Name:
Address:
City:
State:
ZIP:
Telephone (daytime):
Telephone (Evenings):
Occupation:
   
PAWA sponsor's name (if any):
   
Please check the following that apply:  
I am 18 years of age or over
I am of Portuguese heritage
Mother was/is Portuguese
Father was/is Portuguese
I am not of Portuguese heritage
   
I am interested in serving on the following committees:
Education
Community Outreach
Elderly Outreach
Legal
Family Issues
Membership
Fundraising
General Suppport
Publicity

Send check or money order made payable to PAWA in the amount of $25.00. Mail your application and membership fee to:

Susan Pacheco, President PAWA  
197 Taunton Avenue, East Providence, RI 02914