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NORTH AMERICAN SHAGYA‐ ARABIAN SOCIETY, INC. (NASS) A 501 (c) (5) Non Profit Tax Exempt Organization


MEMBERSHIP APPLICATION


PLEASE PRINT CLEARLY FIRST NAME: _______________________ LAST NAME: _______________________________


BUSINESS NAME: ______________________________________________________________ ADDRESS: ____________________________________________________________________ ____________________________________________________________________


CITY: __________________ STATE: __________________ PROVINCE: __________________ POSTAL CODE: _______________ EXT. (+4) _______________ COUNTRY: _______________ E-MAIL: _____________________________________________________________ HOME TELEPHONE: __________________________________________________ WORK TELEPHONE: __________________________________________________


TYPE OF MEMBERSHIP Lifetime Membership


Active Participating Membership Associate Membership Junior Membership


Late Fee – If payment is received after March 31st. Total Amount Due


Make Checks out to “NASS” Mail To: NASS Membership Arlene Michaud


993 Gupton Road Culleoka, TN 38451


___ YES! Add me to the NASS Membership Directory. ___ YES! Add me to the NASS Membership list on the NASS Website. ___ YES! Contact me about volunteering on a committee. ___ YES! Contact me about Advertising in the NASS Membership Directory.


Form 100 Rev. 07/11/10


Renewal _____ New _____ Renewal _____ New _____ Renewal _____ New _____


Newsletter Only – hard copy printed via regular Mail from your Regional Director.


Please ADD


$200 $45 $45 $25 $25


$10 $


Page 22


NASS NEWS Summer 2010


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