Membership Form

 

Corporate Membership / Individual  Membership

 

Please fill in the membership application form. All required fields are marked with *.

Personal Information
Salutation Preference:   Mr.    Ms.    Mrs.    Dr.    Other: 
First Name: *   M.I.  Organization:
Last Name: * Title/Position:
 
Contact Information
*  Home    Work
Street Address *
Email address:

While not required, providing your email address will ensure timely delivery of member-only announcements.
City: * Phone: * x
e.g., 5025551234
State & Zip: *   Fax:
e.g., 5025551234
 
Business Information
Business Address
Website:
City: Phone:   x
e.g., 5025551234
State & Zip:   Fax:
e.g., 5025551234
 
Interests & Membership Information
* Membership Level
Corporate Membership:
 Corporate Member / $1,000
 Corporate Benefactor / $2,500
 Corporate Patron / $5,000

For Individual Membership levels, click here.
 
* Payment Options:
 I will pay with credit card online  Accepted credit cards

If you would prefer to pay by check, please mail it to:
World Affairs Council of Kentucky and Southern Indiana
200 W. Broadway, Ste 607
Louisville, KY 40202

 
Comments:

Please provide any information that will help us understand your membership interests. E.g., foreign languages you speak, countries in which you have a particular interest, activities you would like to participate (interpreting, hospitality, etc.):

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