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HomeMember Renewal Form

RENEWAL APPLICATION 2018-2019

Please note:   RENEWALS MUST BE RECEIVED NO LATER THAT MAY 2, 2018 OR

SUBJECT TO A $20.00 LATE FEE.                                                                    Classification_______

 

Name_______________________________________________Date of Birth______________

Mailing Address__________________________________________City:__________________

State__________________ Zip _________________ Home Number _____________________

Home Email_____________________________________ Cell Number___________________ 

Business or institution:__________________________________________________________

Business Adddress_________________________________________City___________________

State____________________ Zip _________________ Business Phone ____________________ 

Business Email__________________________________________________________________

Location to receive Zonta Mail:               ( ) home or ( ) business

Location to receive Zonta Email:            ( ) home or ( ) business_____________________________ 

Yes, I want to renew my membership in the Zonta Club of Parker County, and I subscribe to the objectives of this organization.

Dues:                      $83.00                    Annual membership dues-International and National

                                    $28.00                    District

                                    $40.00                    Local Dues

                                    151.00                    * Add $20.00 after May 2, 2018

                                    $___________Donation to International Foundation -___________________

 

Optional               To include annual lunch fees add $96.00 for 8 meetings @ $12.00 each 

 

*If you wish to pay by credit card we will need the credit card #_________________________

Type of Card_______________, expiration date _____________ and security code_________

 

Membership Signature:_______________________________ Date______________________

                                              Mail form and check to Zonta Club of Parker County

Zonta International is a leading global organization of professionals empowering women worldwide through service and advocacy

 

P. O. Box 2095                      Weatherford, Texas 76086               www.zontaparkercounty.org