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Ikebana International Columbus Chapter #84

Ikebana International Chapter #84 Columbus, OH Member Dues Form

DUES YEAR: JULY 1, 2021 THRU JUNE 30, 2022

Name:________________________________________________________________________

Address:______________________________________________________________________

City:_______________________________________Zip:________________________________

Home Phone:_______________________________Cell:_______________________________

Email:________________________________________________________________________

Birthday: M/D______________________________Spouse Name:_______________________

Check #________________Amount:___________________Date on Check:_______________

II #84 Member Number:_________________________School__________________________

ANNUAL DUES ARE $60, SEND TO MEMBERSHIP CHAIR(Joyce Ellison) -

MAKE CHECKS PAYABLE TO: Ikebana Int. Chapter 84

Mail to -

Joyce Ellison

6054 Waterloo Rd

Dayton, OH 45459

*FILL IN TOP AND BOTTOM HALF (Do not detach) DUE DATE: MAY 31, 2021

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

TREASURER’S COPY

DUES YEAR: JULY 1, 2021 THRU JUNE 30, 2022

Name:________________________________________________________________________

Address:______________________________________________________________________

City:_______________________________________Zip:________________________________

Home Phone:_______________________________Cell:_______________________________

Email:________________________________________________________________________

Birthday: M/D______________________________Spouse Name:_______________________

Check #________________Amount:___________________Date on Check:_______________

II #84 Member Number:_____________________________School__________________

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