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USIC DUES STATEMENT |
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Under |
Over |
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Age 35 |
Age 35 |
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Minimum Payment |
$60 |
$125 |
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For purposes of dues payments,
a person will be considered age 35 if he or she will attain that age
at any time during the calendar year. Honorary Members and winners of
the Johnston or Danzig Award are not required to make any annual payment;
however, voluntary contributions would be greatly appreciated. The USIC
is a 501 (c) (3) tax exempt organization as determined by the IRS. Please
make your check payable to "USIC" and mail it with this completed
form by
June 15 to: |
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New Member? ______ Amount Paid:________ Ck:________ Cash:_______ Date:___/___/___ |
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Please help us update our records
by providing the information requested below: Name:_____________________________________
Date of Birth:__/__/__
Age Group________
(as you wish it to appear in yearbook) Home Address:__________________________________________________________________________ Phone No.:_____________________
Email:___________________ Business Address:________________________________________________________________________ Phone No.:_____________________
Email:___________________ NB: Date of birth is for match purposes only and will not be published. Please indicate if any of your other contact information should not be published. |