AFTJ, Inc. Membership Form 2009-2010 Please print out this form and return it with your payment. Thank you. ANNUAL AFTJ, Inc. Membership Dues: for September 2009 - August 2010 Membership TEACHER MEMBERSHIP: ____ Annual AFTJ Membership Dues and NCJLT Membership - $40.00 (note: this payment is due by November 1, 2009) ____ Annual AFTJ Membership Dues - $25.00 STUDENT MEMBERSHIP: ____ Annual AFTJ Student Membership Dues - $5.00 (This will entitle students to reduced admission at all AFTJ sponsored cultural events such as Japan Immersion Day, Speech and Skit Contest and Cultural Workshops.) Status of student must be verified below by teacher or professor. PARENT MEMBERSHIP: ____ Annual AFTJ Parents' Membership Dues - $10.00 (This will entitle up to two parents to free admission to AFTJ sponsored cultural workshops, the Tidings Newsletter and an invitation to Japan Immersion Day.) FRIENDS OF AFTJ (BUSINESSES AND OTHER SUPPORTERS): ____ Annual Supporter Dues - $10.00 Name: _________________________________________________________ Address: _______________________________________________________ City: _____________________________ State: ________ Zip: _________ Home Phone: (____) ______________ E-Mail: ____________________@_____________________ School/Business Name: ___________________________________________ Address: _______________________________________________________ City: _____________________________ State: ________ Zip: ____________ Business Phone: (____) _______________ For students, please have your teacher/professor verify your status with a signature below: Student status verified by: _______________________________ Signature: __________________________________ Please accept your cancelled check as receipt for your membership. Please make your check payable to AFTJ and submit to: Marci Muench AFTJ Treasurer 22024 Flanders Court Boca Raton, FL 33428 |
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