ARIZONA BUFFALO SOLDIERS ASSOCIATION
1201 E. MICHIGAN ST. TUCSON, ARIZONA 85714
PHONE/FAX: 520-xxx-xxx
Membership Application, Renewal
and Contribution Form
Renewal: _____ New Member: _____ Contribution: _____ Group or Organization:
_____
Date: __________ if renewing, please give current membership number if known __________
Name of Group or Organization:
_________________________________________________
First Name: ________________________________________________ Contact Person _____
Last: ________________________________________________
Address: ________________________________________________________________________
City: ________________________________
State: __________Zip Code:__________
Phone Number ___________________ Gender (M) or (F) _____
E-mail Address ________________________________________________
Are you 18 years old or older? ____ Must be at least 18 to become a Full Member.
Are you 55 or older? ____ Full Members only
are you retired? ____ Full Members only
Please make checks payable
to ARIZONA BSA
Annual Membership
Your Individual Contribution
Type of Membership
Level of Contributions
____Full Member.…$25.00
E1………..……. $100.00 ____
____Associate... ….. $25.00
E2……................ $250.00 ____
____Renewal ……... $25.00
E4……………... $400.00 ____
____Initiation Fee… $25.00 New
Full Member only
E5……………... $750.00 ____
____New Member… $25.00 If joining January – April
O1…………... $1500.00 ____
____Contribution Amount:
__________
O2... ………… $2500.00____
All contributions ARE NOT tax deductible
O3....................$5000.00
____
O4………….$10,000.00
____
All Dues are due 15 JANUARY of each year.
O5
………..$15,000.00 ____
All New Members are required to read the Bylaws. I have read the bylaws
____. My answers are true and complete. I understand that if I am accepted, any false
or incomplete statements in this application will be grounds for immediate termination of membership. Your are paying by, Check ____ Cash ____ Money Order ____ Other ____________
Date: _________ Amount enclosed _________ Applicant's Signature: _________________________
