Becoming a Member of tacam

version 5 – oct 2009 ea

Becoming a Member of tacam

SELF SPOUSE CHILD OT HER M F

1  ________________________________ ◯ ◯ ◯ ◯ ◯ ◯ ____________ ________________________

2  ________________________________ ◯ ◯ ◯ ◯ ◯ ◯ ____________ ________________________

3  ________________________________ ◯ ◯ ◯ ◯ ◯ ◯ ____________ ________________________

4  ________________________________ ◯ ◯ ◯ ◯ ◯ ◯ ____________ ________________________

5  ________________________________ ◯ ◯ ◯ ◯ ◯ ◯ ____________ ________________________

member namesfirst, last (If different)

 relationship  sex  birth date mm/dd/yyyy (Optional)

 e-mail address

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.

◯ $100.00 Family (including children under 18)$ ___________ . ____

◯ $50.00 Single Adult > (qty. _______ x $50.00) > $ ___________ . ____

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

◯ I am enclosing a donation for the Turkish School for > $ ___________ . ____

◯ I am enclosing a donation for the Building renovation project for > $ ___________ . ____

◯ I am enclosing a donation for the Anatolian Voice (newsletter) for >$ ___________ . ____

◯ I am enclosing a donation to tacam for > $ ___________ . ____

street address

family last name home phone

FOR INTERNAL USE ONLY - DO NOT WRITE IN THIS SPACE

MEMBER # __________ CHECK # ___________________________ MEMBER SINCE ____________ DATE POSTED & INITIALS ________________

HouseholdInformation

state / province zip / postal codecity

city

MembershipPayment andDonationInformation

total enclosed $ ___________ . ____

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MemberInformation