PLEASE PRINT FORM BELOW AND MAIL IT, TOGETHER
WITH YOUR PAYMENT INFORMATION, TO:
The World Affairs Council of Orange County
2102 Business Center Drive
Irvine, CA 92612
Tel: 949-253-5751 Fax: 949-253-5752
Membership Application
Yes, I want to Go Global and join the World Affairs Council. Please enroll me in the following category:
____ Student Membership at $25 (with valid student ID)
____ Individual Membership, at $95
____ Couple/Family Membership, at $150
____ Consul Membership, at $350
____ Diplomat Membership, at $850
____ Ambassador’s Circle, at $1,600
Corporate Memberships
____$2,600 Bronze Sponsor
____$5,000 Silver Sponsor
____$10,000 Gold Sponsor
____$20,000 Platinum Sponsor
Name(s) _____________________________________________________________________________________
Company ____________________________________________________________________________________
Address: _____________________________________________________________________________________
Home Telephone ( )________________________________________________________________________
Work Telephone ( )________________________________________________________________________
Fax ( )____________________________________________________________________________________
Cell Phone ( )________________________________________Date of Application_____________________
Email _______________________ @ ______________________________________________________________
Referred by ___________________________________________________________________________________
Credit Card No. _____________________________________________________________ Exp. ______________
Credit Card Type (circle one): VISA MASTERCARD AMEX
Checks made payable to the: World Affairs Council
