Please provide the following information and we will sign you up for membership. Primary Member: Title: Mr. & Mrs.Mr. Mrs. Ms.Dr. Dr. & Mrs.Dr. & Dr.Miss First Name: Last Name: Phone: Email Address: Spouse: Title: Mr. & Mrs.Mr. Mrs. Ms.Dr. Dr. & Mrs.Dr. & Dr.Miss First Name: Last Name: Phone: Email Address: Company Name: 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: I wish to join the Young Professional (I am age 40 or under) Basic Premier Form to load one line of events table $250 Family $5000 Diplomat Form to load one line of events table $150 Individual $2500 Statesman Form to load one line of events table $75 Young Professional $1200 Ambassador Form to load one line of events table $10 Full-time Student $750 Benefactor Form to load one line of events table $500 Patron Mail membership dues along with a copy of your confirmation Email to: World Affairs Council of the Florida Palm Beaches, 2806 Black Oak Way, Boynton Beach, FL 33436-6609 The Council is a non-profit, 501(c)(3), corporation so donations and dues may be tax deductible to you or your corporation. World Affairs Council of the Florida Palm Beaches
Basic Premier Form to load one line of events table $250 Family $5000 Diplomat Form to load one line of events table $150 Individual $2500 Statesman Form to load one line of events table $75 Young Professional $1200 Ambassador Form to load one line of events table $10 Full-time Student $750 Benefactor Form to load one line of events table $500 Patron Mail membership dues along with a copy of your confirmation Email to: World Affairs Council of the Florida Palm Beaches, 2806 Black Oak Way, Boynton Beach, FL 33436-6609 The Council is a non-profit, 501(c)(3), corporation so donations and dues may be tax deductible to you or your corporation. World Affairs Council of the Florida Palm Beaches
World Affairs Council of the Florida Palm Beaches
