Membership Application
Please print and complete.

Family Name:
Address: City State Zip
Father's Name: Occupation
Business Address: City State Zip
Mother's Name: Occupation
Business Address: City State State Zip

Children in family
Name School Attending Age Birth Date
. . . .
. . . .
. . . .
. . . .
. . . .

Membership Categories (choose one)
Sponsor ($100)
 Patron ($50)
Family ($25)
Individual ($15)

Family membership is required for all applicants interested in Interchange, Seminar Camp, Summer Camp, or Village. No additional membership dues are required to participate in Junior Branch Activities, but specific application fees may be required for certain programs. CISV fiscal year is January 1 - December 1. Dues are paid annually.


Contributions (Designate Contributions)
CISV VILLAGE FUND. This fund is for financing the Villages or Summer Camps held locally by our chapter.
The Andy Shockley Scholarship Fund. This is a fund set aside to make CISV programs available to children whose  parents may not be able to finance them.
The Ray and Elizabeth Shrader Endowment Fund. This fund supports general chapter activities.

Please make you check payable to CISV, INC.  All funds are tax deductible.
Mail completed form with your check to:
Membership Chairman
Smoky Mountain Chapter, CISV
17 Radcliff Terrace
Oak Ridge, TN 37830