MEMBERSHIP FORM Title of the document Applicants are asked to complete the following information. Starred items(*) are required. After completing this form, click ‘Submit’. A copy of this application will be emailed to you. Or you can also print this form and mail it to the address below. Member Information: *First Name: *Last Name: Nickname: (Badge Name) Spouse/Partner Information: First Name: Last Name: Mailing Address: Address1: (Address) Address2: (Ste/Suite) City: State: AlabamaAlaskaAlbertaAmerican SamoaArizonaArkansasBritish ColumbiaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineManitobaMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew BrunswickNew HampshireNew JerseyNew MexicoNew YorkNewfoundland and LabradorNorth CarolinaNorth DakotaNorthern Mariana IslandsNorthwest TerritoriesNova ScotiaNunavutOhioOklahomaOntarioOregonPalauPennsylvaniaPrince Edward IslandPuerto RicoQuebecRhode IslandSaskatchewanSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandVirginiaWashingtonWest VirginiaWisconsinWyomingYukon Postal Code: Phones(s) (All listed phone numbers will be published in the Club's Roster): Home Phone: Cell Phone: Cell Carrier: {select}noneAliantAlltelAmeritechAT&TBell CanadaBell Mobility CanadaBellsouthBellSouth MobilityCellular SouthCellular SouthCellularOne (Dobson)CellularOne WestCentennial WirelessCincinnati BellCricketEdge WirelessMetro PCSMetrocall PagerMobileOneMTN ZANextelPCS RogersPowertelPSC WirelessQualcommQwestRogersSatelindo GSMSimple FreedomSprintSprint NextelSprint PMT-MobileThe Phone HouseTracfoneU.S. CellularVerizonVirgin Mobile USAVodacom ZAVodafone SpainVodafone UK * EMail: Please tell us more about yourself / Share your Interest, Skills & Background: Which of our Sister City Relpationsups are you most Interested In? Dunfermline, Scottland Hamilton, Canada Merida, Mexico Perpignan, France Rapperswil-Jona, Switzerland Tel Mond, Israel Treviso, Italy Vladimir, Russia Xiamen, China Membership Levels: Individual $40 Family $60 Patron $100 Sponsor $150 National Sponsor $500 Return Check - Money Order payment to: Sister City Assoication of Sarasota, Inc. 111 S. Orange Ave. Suite 103 Sarasota, FL 34236 Phone: 941-312-1032 E-mail: membership-vp@sarasotasistercities.com If you are paying by check, please print the completed application now. Click here to print. Thank you for applying for membership with Inliners International. To complete your membership application, a payment of $ is now required. Please select the payment method below: Pay by check - click here Pay by credit card - click here Was this page helpful? Let us know if you liked the post. That’s the only way we can improve. Yes No
