MEMBERSHIP FORM
PRINT THIS FORM AND MAIL TO:
____New Member
_____Renewal Member
Name ___________________________ Spouse_______________Children______________
Company Name (if applicable)___________________________
Mailing Address______________________ City __________ State___________ Zip______
Home Phone____________ Home Fax___________________ Home E-Mail_____________
Work Phone____________ Work Fax_________________
Work E-Mail_____________
Annual Membership (calendar year)
___family $30
___Adult $20 per Person
___Senior $10 per Senior
____youth $5 per Youth
____Business $100(Up to 15 emplyoyees)
____Business$300(over 15 employees)
Interest Areas:
____exchanges
____Host Family
____Lerdo Committee
____Nienburg Committee
____Other_________________________________________________________