Application Form

SISTER CITIES ASSOCIATION OF VOLUSIA COUNTY, INC.

MEMBERSHIP REGISTRATION

(please print)

Name __________________________________________________Date______________________

Address__________________________________________________________________________

Telephone:  Business _____________ Residence _______________ E-Mail ___________________

Occupation/Special Interests:  _______________________________________________________________________________

Please check committees you are interested in:

Publicity ____Hospitality _____ Program _____ Phoning _____ Newsletter _____ Health ________

Membership ______Education _______ Business _______Fundraising ______ Other? __________

Are you interested in traveling to:     

 Campeche, Mexico _________ Bayonne, France _________

Types of exchanges in which you would like to be involved:

Business ______ Education _______Health Care ______ Cultural _______ Other _____________

Dues:        Student $10.00                    Individual $ 25.00            Family $ 35.00      

                 Organization $ 100.00       Corporate $ 250.00            Benefactor $ 500.00

Donation of services: _____________________Check # ____________ Cash $ ___________

Please make check payable to Sister Cities Association of Volusia County, Inc.

and mail it along with this form to:

Sister Cities of Volusia County, Inc. , P.O. Box 2507, Daytona Beach, FL 32115