Membership Application
 

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

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Membership Categories (choose one)

 

oSponsor ($100)

 

o

 Patron ($50)

 

o

Family ($35)

 

o

Individual ($20)

 
             

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)

o

CISV VILLAGE FUND. This fund is for financing the Villages or Summer Camps held locally by our chapter.

 

o

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.

 

o

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:

Laura Davenport,  CISV Treasurer

140 Country Run Circle

Powell, TN  37849