Zonta International District 15

Prospective Member Questionnaire Form

Zonta is an international service organization working to advance the status of women through service and advocacy. Members of Zonta Clubs are actively engaged or have experience in a decision-making capacity in a recognized business or profession.

If you are a professional or a business executive and you are interested in becoming a member of a Zonta Club in District 15, complete this form.

* Dues - new members joining between June 1 - Nov 30: District $20.00; International $80.00 plus $3.00 insurance (U.S.D.) - Payable to District 15 and International.

* Dues - new members joining between Dec 1 - May 1: District $10.00; International $40.00 plus $3.00 insurance (U.S.D.) - Payable to District 15 and International.

* Individual club dues may also be collected.

Name First Last
Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Ph. # (residence) ### - ### - ####
Ph # (work) ### - ### - ####
Email
Occupation/
Profession
Job/Position Title
Please contact me by:

The District 15 Membership Chair will contact you soon.
Thank you!
Phone (residence) Phone (work) Email Mail
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