Persia House of Michigan (Khaneh Iran) Membership Application

Persia House of Michigan (Khaneh Iran) Membership Application

دعوت به عضویت ویا ادامه هموندی در خانه ایرانهموندی و یا ادامه عضویت شما در خانه ایران برای ما خوشحالی بسیار به ارمغان می آورد. امیدواریم که با شرکت فعال خود در برنامه های آینده ما در پیشرفت هر چه بیشتر خانه خود شریک باشید. لطفا فرم زیر را پر کرده برای ما ارسال دارید.Persia House of Michigan (Khaneh Iran) Membership ApplicationFirst Name: ___________Last Name: ___________Address: ______________Apt. #: ________________City: __________________State: _____ Zip Code: ________Phone: _________ Fax: ________E-mail: ______________________Spouses First Name: ______________Spouse’s Last Name: ______________Children’s Name & Date of Birth _________________Interest Group Participation:Committees, you like to cooperate with:– Literature & Art – Education – Lectures– Entertainment & Events – Lady’s Club – Cinema– Publication & PR – Management Club – Library– Sports & Recreation – Membership – Music– Javanan –Theater – Iran Night – Diversity & ParentingType of Membership:– Family I, Spouse & Children Under 18 $40– Family II, Spouse & Children Under 18 Plus Parents (same address) $50– Single $25.00– Student $20.00– Senior $20.00– Additional Donation: ___________Method of Payment:Check no.: _______ Amount: ______To become a member or to renew your membership, Please fill out the above form, include your check and Mail it to us. We thank you for your cooperation.نام و نام خانوادگی بفارسی:

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vol2_no3_fall2003.pdf

Persia House of Michigan

2003 - Fall

vol2_no3_fall2003.pdf (p.2)

application/pdf

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