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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 $75
______
Couple/Family Membership, at $125
______ Consul Membership, at
$300
______ Diplomat Membership, at $750
______ Ambassador's
Circle, at $1,500
______ Corporate Membership at
$2,500
Name(s)
______________________________________________
______________________________________________________
Company (if relevant)
_______________________________
Address:
______________________________________________
______________________________________________________
Home
Telephone (
)______________________________
Work Telephone (
)_____________________________
Fax (
)___________________________________________
Cell Phone (
)____________________________________
Email
___________________ @ ______________________
Date of Application
_________________________________
Referred
by ________________________________________
Credit Card No.
_____________________ Exp. __________
Credit Card Type
(circle one) : VISA
MASTERCARD
SIGNATURE
_______________________________________
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