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 $12.00    Single Triennial $30.00 
Dual Annual $13.50     Dual Triennial $34.50 
Youth Annual $4.00    Youth Triennial  $10.00

Overseas, outside AIS Regions, 

Overseas
Single Annual

 $19.50 

Overseas  
Single Triennial

 $52.50 

Overseas
Dual Annual

 $21.00 

Overseas   
Dual Triennial

 $57.00 

Overseas
Youth Annual

 $9.00

 Overseas
 Youth Triennial 

 $25.00
AIS Member?   (Please Check) YES  NO 
New Membership                  Renewal Membership 
Expiration Date     
 
Mail CHECK and FORM To:

Carolyn Ash
9313 Alden
Lenexa, Kansas 66215
Email: irishappygal@hotmail.com

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