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To The Membership and Classification Committee, Zonta Club of Parker County: I would like to submit the following name for possible membership:     2017-2018

Sponsoring Member: ___________________________ Date:__________________________

Name_______________________________________ Date of Birth______________________

Mailing Address__________________________City:____________ST__________Zip________

Home Phone______________________________        Cell Number_______________________

Home Email____________________________________________________________________

Business or Profession___________________________________________________________

Business Address_________________________City____________ST__________Zip_________

Business Phone__________________________ Fax____________________________________

Business Email__________________________________________________________________

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

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

What is the individual’s executive position or title with their business?____________________

Does the individual give 50% or more time to the business or profession listed ( ) yes ( ) no

Other Civic and Club Affiliations:___________________________________________________

Yes I want to become a member of the Zonta Club of Parker County, and subscribe to the objectives of this organization.

Dues:               $83.00             Annual membership dues-International and National

                        $28.00             District

                        $15.00             One-time membership fee

                        $40.00             Local Dues


                       $____________Donation Made to International Foundation________

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


Please check the committees in which you would like to serve. ( ) Membership & Classification,

( ) Advocacy, ( ) Status Of Women Service & United Nations, ( ) Attendance & Fellowship,

( ) Programs & Intercity Committee, ( ) Scholarship Committee, and ( ) Finance.

Applicants 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