|
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
|
