JACL GIFT MEMBERSHIP INVOICE

Name of Chapter _____________________________________________________________________________________
Title ________________ 1st Name______________________ MI___________ Last Name________________________
 
 
Address:
 ________________________________________________________
 
City:
 ________________________________________________________
 
Email:
 ________________________________________________________
 
Spouse's Name
________________________________________________________
 
For Couple / Family Membership
    
 
Type of Membership: (please circle / fill in)
    
 
National Dues    
Chapter Dues
Total
Youth $20
+
 $_________
= $_______
 Regular  
+
 $_________
= $_______
Couple / Family  
+
 $_________
= $_______
Thousand Club Spouse  
+
 $_________
= $_______
Thousand Club  
+
     
= $ 100
Thousand Club Life  
+
= $ 1,000
Century Club  
+
= $ 175
Century Club Life  
+
= $ 2,000
     
Chapter (if applicable): _______________________________________________________________________
 
Giver's Name:
 _______________________________ Mem ID : ___________________________
 
 Address:
 _____________________________________________________________
 
 City:
    State:  Zip:
  Email:
       

Amount Paid:
$ ________________

Date: __________________

 

Would you like notification: Yes ____ No ____

 Attention Seller!
Upon completion, please mail application, along with check, to:

JACL Membership
P.O. Box 7144
San Fracisco, CA

Thank you for your support of the Japenese American Citizens League (JACL)
Please allow 4-6 weeks processing time after Nattional JACL receives payment.