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: Secondary Member: 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: Form to load one line of events table $5000 Diplomat Form to load one line of events table $2500 Statesman Form to load one line of events table $1200 Ambassador 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
Form to load one line of events table $5000 Diplomat Form to load one line of events table $2500 Statesman Form to load one line of events table $1200 Ambassador 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
