Request for Membership Form - Altrusa

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Recommendation for Membership Form

Altrusa International, Inc.

Membership Dues*

Altrusa International and District Eleven Yearly Dues ($80.00)
Full Year Dues for Altrusa International, Inc
Year runs June 1 - May 31st
$55 - International Dues
$25 District Dues
Note: Dues Paid between April 1 and May 31 are good through May 31 of the following year
Half year Dues ($40.00)
Young Professional pay half year dues and members joining after Dec 1 pay half year dues

New Member One Time Fee*

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

Name*

Email*

Primary Phone Number*

Address*

Home Phone

Business Phone Number

Date of Birth*

Other club/organization affiliations:

Why do you want to join Altrusa?

How do you want to receive your publications*

Profession/Occupation

Sponsor Name*

Sponsor's Membership ID*

Co-Sponsor

Co-Sponsor Membership ID*

Date Initiated*

Membership Committee Approval*

Member is approved

Approved by (Please Initial)*

Approval Date*

Club Approval*

Club Voted to Approve New Member

Approved By (please initial)*

Approval Date*

Club Location*

Signature*

Date of Application*

Convenience Fee of 0.99 and 3.99% will be added

$4.58

Running Total

$94.58

Total

$94.58

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