Membership Form

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Membership Form

Fill in the form below to apply for membership to the Committee. Print out the completed form and mail it in with your payment in US$ drawn on a US bank. Annual Dues are $35.00 for Regular Membership or $15.00 for Student Membership.

Membership Type: * New Member Renewal

Your Information

Mr/Mrs/Ms/Dr: * First Name: * M.I.: Last: *
Address 1: *
Address 2:
City: * State: * Postal Code: *
Country: *
Phone:
Your Email Address: *

Do you represent an organization? Information About Your Organization

Organization Name: *
Accredited by: * ECOSOC UNDGC Both Neither
City: State:
Country:
Your Title / Position:

Membership Dues and Contributions

Dues (Jan 1 - Dec 31): $35.00 Regular Membership or $15.00 Student Membership:
+ Contribution to NGO Committee on Ageing:
= Total payment by check payable to NGO Committee on Ageing in US$ drawn on a US bank:

Please complete and mail this form with payment to:
NGO COMMITTEE ON AGEING
PO Box 1854
New York, NY 10163-1854

The NGO Committee on Ageing

Mail-in Membership Form