To join the BWLC, please complete the following membership form: Select Membership Level*Xerox Employee ($25)Employee of a Wholly Owned Xerox Subsidiary or Xerox Affiliate ($25)Friends of BWLC ($35)Friend Type*Xerox RetireesContractorsFamily MembersFriendWhat Year?*This Year (2012)Next Year (2013)Payment Method*PayPal (Xerox Affiliates/Subsidiaries & Friends of BWLC)Payroll Deduction (Xerox employees only - not available for Xerox Affiliates/Subsidiaries at this time)Name*FirstLastEmployee ID*Email*Division/OrganizationJob FieldAccounting / FinanceClient Relationship Management / Service DeliveryCustomer Support & AdministrationGeneral Management / StrategyHuman Resources / TrainingInformation TechnologyInternal Services / SecurityManufacturingProfessional Services / Project ManagementResearch & Development Engineering / SupportSales & Marketing / Creative ServicesTechnical Customer Services & SupportTitlePhone*Address*Street AddressAddress Line 2CityState / Province / RegionZip / Postal CodeAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayNorthern Mariana IslandsOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabweCountryEducation LevelCompany or School Name*Years of Service*Years at Company*Employee Status*ExemptNon-ExemptIntern/Co-opAge Range20 to 3031 to 4041 to 5051 or aboveBWLC Chapter*Georgia (incl. AL, NC, SC)Florida & IslandsMid-Atlantic Region (incl. , MD, DC, DE, WV, VA)California (incl. AZ, OR, NV, UT, WA, HI, AK)Monroe County (incl. Buffalo)Detroit (incl. all of MI & Ontario, Canada)Texas (incl. AR, MO, LA, IN, MN, TN, NM, OK, CO, KS, NE)Chicago (incl. IA, WI)Northeast (incl. NYC, PA, NJ, CT, MA, OH, KY)How would you like to serve in BWLC?Where NeededProgrammingCommunicationsCommunity ServiceRegional OpportunitiesMentoring OpportunitiesHow did you hear about the BWLC?