MEMBERSHIP APPLICATION

[ ] Benefactor Member: ($500.00)

[ ] Sustaining Member: ($300.00)

[ ] Regular Member: ($50.00)

[ ] Senior Member: ($20.00)

[ ] Student Member: ($15.00)

The Tunisian Community Center is a 501©3 organization. Donations are tax-exempt

Email Address: *___________________________________________

First Name: * ___________________Last Name: *_________________

Address: (Optional)_______________________________________________________

City: * ________________________State:*_______ Zip____________

Phone:(Optional)___________________________________________

Make checks or Money Order payable to:

Tunisian American Center

PO Box 837

Clifton Park, NY 12065-0801