Median Iris Society - Application

JOIN THE MEDIAN IRIS SOCIETY, Inc.

USE THIS FORM TO JOIN
(Fill out & Print this page. Mail the completed page with your dues)
You may either print this as a blank page and fill it out by hand,
or fill it out now, then print the completed page.

THIS PAGE DOES NOT SUBMIT ANY INFORMATION VIA INTERNET.
IT IS FOR YOUR CONVENIENCE ONLY.

Name:
Address:
City:
State:		Zip:
Phone:
E-mail:

Membership Dues (Please CHECK "X" appropriate selection)
Single Annual	$8.00	Single Triennial	$20.00
Dual Annual	$9.00	Dual Triennial	$23.00
Youth Annual	$4.00	Youth Triennial	$10.00
Overseas, outside AIS Regions, add $5.00 per year to cover additional cost of postage.
Overseas Single Annual	$13.00	Overseas Single Triennial	$35.00
Overseas Dual Annual	$14.00	Overseas Dual Triennial	$38.00
Overseas Youth Annual	$9.00	Overseas Youth Triennial	$25.00
DUAL MEMBERSHIPS
Single LIFE	$150.00	Dual LIFE	$200.00
Single Life Overseas	$250.00	Dual Life Overseas	$275.00
AIS Member? (Please Check) YES NO
New Membership Renewal Membership Expiration Date

Mail CHECK and FORM To:

Rita Gormley
Membership Chair
10616 Timber Ridge Street
Dubuque, IA 52001-8268

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