MEMBERSHIP APPLICATION

Full name

I.D. number

Citizenship

Birthplace

Spouse´s name

Spouse's I.D. Number

Spouse's citizenship

Name of children

Ages of children

Occupation

Employer

(Please note with and "X" where correspondence should be sent.)

Business address

Phone

e-mail

Phone

Sponsor's name
(if any)

Have you ever been a member of another American Society

Yes No

when

Where

What activities are you most interested in

Are you interested in advertising in our web page?

Yes No

Signature date

Would you be interested in working on one of our activities?

Yes No

Suggestions and Comments