| Membership Form |
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| Downloadable versions PDF WORD | |
India Association of Fort Myers, Inc. Membership Application Form |
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| I / we would like to become a member as follows: | |
| ___________________NEW MEMBER | ___________________RENEWAL |
| Individual : | $50.00 |
| Family : | $75.00 |
| Life Membership Individual : | $750 |
| Life Membership Family : | $1000 |
| I am including a check for $ _______ payable to India Association of Fort Myers, Inc. P.O. Box 07183, Fort Myers, FL 33919. | |
| Please use BLOCK LETTER and print your information; no cursive hand writing. | |
| Name: _________________________ | Spouse: _______________________ |
| Name Of the Children: 1. _______________________ | 2. ___________________________ |
| 3. _______________________ | 4. ___________________________ |
| Address: ___________________________________________________________ | |
| City: ________________ State ________________ Zip ________________ | |
| Phone: Home: (_____)___________________ Business: (_____)____________________ | |
| Cell: (_____)____________________ E-Mail: (_____)_____________________ | |
| ________________________________
SIGNATURE OF THE APPLICANT |
________________________
DATE |
| I would like to _____include______ not include the above information in the membership directory.I would like to receive my Newsletter or other correspondence via_____E-mail or ____US Postal Service | |
| The India Association of Fort Myers, Inc. is a charitable organization registered in the State of Florida, and is tax-exempt under Section 501(c)(3) of the Internal Revenue Code. | |
