City Clerk's Office

AIPCA Membership Form

Membership Year
July 1 - June 30

___________________________________________________
Your name

___________________________________________________
Your address

___________________________________________________
City, State, Zip

___________________________________________________
Telephone number

Your interests:
__ Hosting
__ Education & Youth Exchange
__ Cultural Programs & Exchanges
__ Public Relations
__ Other ____________________________________

Donations are tax deductible

Contribution Category ___________
Active, $25
Supporting, $50
Sustaining, $100
Patron, over $100

Membership Dues ____________
Individual, $15
Family, $25
Student (K-12), $5

Total Enclosed ____________

Mail application and check to:
Ames International Partner Cities Association, Inc.
City Manager's Office
PO Box 811
Ames, IA 50010