Bay Area Iranian-American Democrats (BAIAD) Membership Form:

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Membership

Email *

Option 1

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Option 1

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Untitled Title

Option 1

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a *

Last Name:Hamadani *

350 Quinnhill Ave Los Altos, ca(same as your3 voter registration): *

650-9488789Phone Number:

Retired

Type of Membership Requested: * *

Regular: $35

Family, includes Immediate relative ( spouse, parent, child): $40

Associate : $25

Student (with valid student ID): $10

Senior Citizen (65 and above): $10

Ex-Official: None

Affiliated Clubs: $50 biennial

Additional donation:

$250

Other:

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If requesting "Immediate Family" type of membership, please provide the name of the "Regular" member in your family: (First and Last Name)

none

Iranian-American Democrats of California (IADC):

EIN# ???????

Address:?????

Phone Number: ??????

Email: ???????

* Membership dues and donations to IADC are not tax deductible.

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