P.O. Box 270048, Austin, TX 78727-0048
MEMBERSHIP APPLICATION
Type of Membership: ___New ___Renewal ___Address Change or Info Update
Name:_____________________________________________ Date of Birth: ___________________
If applying for Family Membership, please provide the names of your spouse & children below:
Name/Relationship Date of Birth
______________________________________________________ ______________________
______________________________________________________ ______________________
______________________________________________________ ______________________
______________________________________________________ ______________________
______________________________________________________ ______________________
______________________________________________________ ______________________
Address __________________________________________________________________________
__________________________________________________________________________
Home Phone: ______________________________ Work Phone:___________________________
Email: ______________________________ Fax:__________________________________
Are you willing to volunteer your time to serve on committees? ___Yes ___ No ___Chair
If yes, please choose one or more committee(s) below. Also Indicate the committee(s) you would
chair.
___Membership ___Performing Arts ___ Food & Concession ___Charity Projects
___Elections ___Program & Presentations ___Tickets/Souvenir Program ___Financial Audit
___Decoration ___Ads & Souvenir Program ___Education & Athletics ___Ways & Means
___Amusement and Recreation ___Prizes and Awards
Annual Membership Dues: (Annual Fees are due on March 15th of each year)
___Family: Couple with children - $ 20.00 ___Family: Couple without children - $ 15.00
___Senior Couple(at least one is 62 yrs old) - $10.00 ___Individual: 18 years old and older - $10.00
___Single Parent with children - $15.00
Signature:_____________________________________________ Date: ______________________
Please return this completed form with your membership dues to the above address.
Maraming Salamat Po!
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The following information is optional and will not affect your application for membership:
Referred by: ______________________________________________________________________
Names and Addresses of others you know who may be interested in joining P.A.S.A.:
_________________________________________________________________________________
_________________________________________________________________________________
Revised: 1/20/04