CISV Miami County Membership Dues

Membership Level:

 Dues:
Junior Branch (for youth 9-25)

$5.00
Individual        (for one adult) 

$20.00
Family            (children 9-25 are jr branch members)

$35.00
Patron            (includes family membership)

$50.00
Sponsor          (includes family)

$100.00
Sustaining       (includes family)

$250.00
Lifetime          (includes family)

$1,500.00

 

NAME:                                                                                                                                                      
(Please include all family members and birth dates of children. No information is given or sold to anyone!)
ADDRESS:                                                                                                                                               
 

CITY:                                                                               ST:                ZIP CODE:                               
 

PHONE:                                                EMAIL:                                                                                      

* CHECK HERE PLEASE IF YOU WOULD BE WILLING TO HELP WITH CISV!  ______
To further support CISV, I/we would like to donate to the:
DOUG HINES MEMORIAL SCHOLARSHIP (interest distributed) $___________
GENERAL SCHOLARSHIP FUND (all funds distributed)  $___________
OTHER $___________
Membership Level from above: ______________________ Amount for dues $___________

Total of check $___________

Send this form and your check payable to Miami County CISV  to:
Miami County CISV
Post Office Box 836
Troy, Ohio 45373

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