Membership
Application
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You
can print this document, complete it with signature, and mail the original
application to:
AHEA
INC.
PO Box 1199
Grand Central Station
New York NY 10017
| Name: _______________________________ (Please Print or Type) | ||
| Home Address: _____________________________________________ | ||
| Home Telephone: (___) __________ | Business Telephone (___) __________ | |
| Occupation: ___________________ | Title: __________________ | |
| Date of Birth: ________________ | Place of Birth: ________________ | |
| Parents" Nationality and/or Descent:____________________________ | ||
| If Married, Spouce's Name: _________ | Date & Place of Birth: ______________ | |
| Child's Name 1) _______________ | Date & Place of Birth: ______________ | |
| Child's Name 2) _______________ | Date & Place of Birth: ______________ | |
| IF YOU ARE PERSONALLY ACQUAINTED WITH ANY MEMBERS OF THE CLUB WHO CAN ACT AS YOUR SPONSORS, PLEASE LIST THEIR NAMES BELOW. | ||
| 1. ___________________________ | 2. ___________________________ | |
| Date: ______________ | Signature: ____________________ | |
| Note: An application for membership will be considered only when properly completed, signed by applicant and accompanied by the initiation fee of $10.00 and year dues: Individual $20.00 - Family $30.00. (both fees will be returned if application is not approved). | ||
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DO NOT WRITE BELOW THIS LINE
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FOR MEMBERSHIP COMMITTEE'S USE
ONLY
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| 1. Date Application Received:_____________ | 2. Application Approval ______ | |
| Date:_______________ | Date Member notified:___________ | |
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President - Secretary - Treasurer - Councilman |
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