Please provide the following information and we will sign you up for membership. Title: Mr. & Mrs.Mr. Mrs. Ms.Dr. Dr. & Mrs.Dr. & Dr.Miss First Name: Last Name: Spouse Name: Company: Address: City: State: AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KA KY LA ME MD MAs MI MN MI MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Zip: Phone: Email Address: I wish to join the Young Professionals Group. Type of Annual Membership Desired Form to load one line of events table Diplomat.................. $5000 Presidential.............. $5000 Form to load one line of events table Statesman................. $2500 Ambassador................ $1000 Form to load one line of events table Benefactor................ $600 Patron.................... $400 Form to load one line of events table Community Sponsor..... $600 Family.................... $200 Form to load one line of events table Individual................ $125 Student................... $10 Mail membership dues along with a copy of your confirmation Email to: World Affairs Council of the Florida Palm Beaches, 150 Banyan Isle Drive, Palm Beach Gardens, FL 33418-4601 The Council is a non-profit, 501(c)(3), corporation so donations and dues may be tax deductible to you or your corporation. FORM # ADMIN/NEWMEMFORM World Affairs Council of the Florida Palm Beaches
Type of Annual Membership Desired Form to load one line of events table Diplomat.................. $5000 Presidential.............. $5000 Form to load one line of events table Statesman................. $2500 Ambassador................ $1000 Form to load one line of events table Benefactor................ $600 Patron.................... $400 Form to load one line of events table Community Sponsor..... $600 Family.................... $200 Form to load one line of events table Individual................ $125 Student................... $10 Mail membership dues along with a copy of your confirmation Email to: World Affairs Council of the Florida Palm Beaches, 150 Banyan Isle Drive, Palm Beach Gardens, FL 33418-4601 The Council is a non-profit, 501(c)(3), corporation so donations and dues may be tax deductible to you or your corporation. FORM # ADMIN/NEWMEMFORM World Affairs Council of the Florida Palm Beaches
World Affairs Council of the Florida Palm Beaches
