AIPCA Application Form

Print

AIPCA Membership Form
Membership Year
July 1 - June 30

Your Name:  ___________________________________________________ 

Address:  _____________________________________________________

City, State, Zip: _________________________________________________

Phone Number:_________________________________________________

Email:________________________________________________________

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