To become a member of the Dixon Sister Cities Association, please print this
page, fill in the application, send it along with your payment to the
address indicated.
SISTER CITIES ASSOCIATION
DIXON ILLIINOIS & HERZBERG (ELSTER) GERMANY
MEMBERSHIP APPLICATION
Please check type of membership you desire:
( ) Individual |
$10.00 |
( ) Organization |
$25.00 |
( ) Family |
$25.00 |
( ) Business |
$25.00 |
( ) Senior (65 & over) |
$ 5.00 |
( ) Patron |
$50.00 & over |
( ) Youth (under 18) |
$ 5.00 |
( ) Contribution (other) |
—— |
Please register membership and name(s):
Name(s) _____________________________________________________
Address ______________________________________________________
Telephone & E-mail address: _____________________________________
Please indicate below any committee you would be willing to serve on:
( ) Youth Exchange Program |
( ) Membership Committee |
( ) Convention Planning Committee |
( ) Newsletter Committee |
( ) Fund Raising Committee |
( ) Speakers Bureau |
____________________________________ ________________________
Signature of Member, Date
Please return the completed form and membership fee to:
Beverly Shepherd
115 Monroe St. (Make check payable to Dixon Sister Cities Assn.)
Dixon, IL 61021
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