Membership Form

Membership Form

برای عضو شدن و یا تمدید عضویت، لطفا فرم زیر را پر کرده و به همراه چک خود برای ما پست کنید. از همیاری شما سپاسگزاریم.First Name: ....................................Last Name: .................................... -- Dr. -- Mr. -- Ms. -- Other ....... Address: ………………………….Apt.#: …………………………….City: ……………………………..State: ……. Zip Code +4: ………..Phone: …………………………....Fax: ……………………………....E-mail: …………………………..Spouse's First Name:…………………………………....Spouse’s Last Name:………………………………….... -- Dr. -- Mr. -- Ms. -- Other ....... Children’s Name & Date of Birth:…………………………………....…………………………………....…………………………………....…………………………………....Interest Group Participation: Committees, you like to cooperate with: -- Literature & Art -- Education -- Publication & PR -- Membership -- Sports & Recreation -- Javanan -- Entertainment & Public Events -- None of the Above Type of Membership: -- Single $25.00 -- Member, Spouse & Children Under 18 $40 -- Member, Spouse & Children Under 18 + Parents (same address) $50 -- Student $20.00 -- Senior $20.00 -- Donation ……………………....Method of Payment: Cash: ……………………Check no.: ……………Amount: ........................…………:نام و نام خانوادگی بفارسی

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vol1_no1_spr2002.pdf

Persia House of Michigan

2002 - Spring

vol1_no1_spr2002.pdf (p.3)

application/pdf

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