http://www.tacam.org/docs/form_membership

Becoming a Member of tacam

v e r s ion 5 – o c t 2 0 0 9 e a

Becoming a Member of tacam

Household Information

family last name

home phone

street address

city

state / province

zip / postal code

city

Member Information

member names

first, last (If different)

birth date e-mail address

mm / dd / yyyy

(Optional) S E LF

Membership Payment and Donation Information

sex

relationship S POU S E C HILD

O T HE R

M

F

1 ________________________________

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2 ________________________________

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3 ________________________________

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4 ________________________________

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5 ________________________________

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I am enclosing a check for my membership dues for this calendar year. Your membership will begin that day your payment is processed and last a full year from that date. Please make checks payable to tacam and mail to: tacam Membership, p.o. Box 3445, Farmington Hills MI, 48333-3445. ◯

$100.00 Family (including children under 18)

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$50.00 Single Adult > (qty. _______

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$25.00 Student (18 and over) > (qty. _______ x $25.00) >

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I am enclosing a donation for the Turkish School for >

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I am enclosing a donation for the Building renovation project for >

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I am enclosing a donation for the Anatolian Voice (newsletter) for >

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I am enclosing a donation to tacam for >

x

$ ___________ . ____

50.00) >

$

$ ___________ . ____ $ ___________ . ____ $ ___________ . ____ $ ___________ . ____ $ ___________ . ____ $ ___________ . ____ total enclosed $ ___________ . ____

FOR INTERNAL USE ONLY - DO NOT WRITE IN THIS S PAC E

MEMBER # __________ V5 09

CHECK # ___________________________

MEMBER SINCE ____________

DATE POSTED & INITIALS ________________