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Altrusa Longview-Kelso Membership Form
Please use this electronic version of the Altrusa International Inc. District Twelve 2022-23 Dues & Membership Information Form to apply for membership at Altrusa International of Longview-Kelso.
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Please choose one:
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Renewing Member
Reinstating Member
New Member
Transferred Member
Address Change
Deceased
Resigned
Leave of Absence
Other:
Required
Full Name
*
Your answer
Birthday (month, day, year)
*
Your answer
Street Address
*
Your answer
City, State, Zip Code
*
Your answer
Home Phone
Your answer
Cell Phone
Your answer
Work Phone
Your answer
Firm/Corporation/Organization
Your answer
Title/Position
Your answer
Business Street Address
Your answer
Business City, State, Zip Code
Your answer
Club/Organization Affiliations (positions held)
*
Your answer
Sponsor Name
*
Your answer
Co-Sponsor Name
Your answer
Membership Dues Information (both International & District allows payments in 2 installments)
$55 International Dues (pay online Group Tally) (send payment to International office)
$10 International Processing Fee (new) (send payment to International office)
$27.50 International Half Year Dues (12-1 thru 3-31) (send payment to International office)
$20 District New/Renewing/Reinstating Member
$2 District Late Fee (Renewals after June 15)
$10 District Half Year Dues (12-1 thru 3-31)
Local Club Dues (Altrusa Longview-Kelso)
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