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
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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__________________