|

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 |
|
. |
. |
. |
. |
|
. |
. |
. |
. |
|
. |
. |
. |
. |
|
. |
. |
. |
. |
|
. |
. |
. |
. |
|
Membership Categories (choose one) |
|
|
|
|
|
| |
|
|
|
|
|
|
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 |