Affiliate Membership Form - Altrusa International, Inc.

Club in Formation

Affiliate Membership Form

Altrusa International, Inc.

Affiliate Membership is required while a new Club is in Formation

Membership Dues

Altrusa International and District Eleven Yearly Dues ($80.00)
Full Year Dues for Altrusa International, Inc
Year runs June 1 - May 31st
Note: Dues Paid between April 1 and May 31 are good through May 31 of the following year
Young Professional or Altrusa International Half Year Dues ($65.00)
Young Professionals (18-30) pay half price
Half Year Dues for Altrusa International, Inc and District Dues
Note: Dues Paid between April 1 and May 31 are good through May 31 of the following year
Members Half Year Dues ($40.00)
Joining from Dec 1st and March 31st
$27.50 International and $12.50 District Total:- $40.00

New Member One Time Fee

New Member Fee ($10.00)
One time $10 fee to International
Returning Member ($0.00)
Returning Member

Name

Primary Phone Number

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Address

Home Phone

Business Phone Number

Date of Birth

Club in Formation

Signature

Date of Application

Convenience Fee of 0.99 and 4.99% will be added

$5.48

Running Total

$95.48

Total

$95.48

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