AIITCO MEMBERSHIP FORM

AMERICAN INDIAN INTER-TRIBAL CULTURAL ORGANIZATION, INC

TWINBROOK STATION, P.O. BOX 775, ROCKVILLE, MD 20848

First Name:   MI  Last Name  

Address  City   State  

ZipCode     Phone: Home   Work Cell

 Email 1 Email 2

Would you like the 'Rattle and Drum by e-mail or a paper copy ?

Type of Membership 

  Annual Dues: $14.00 - Individual (18 and over)      $18.00 - Family (includes children 17 and under)

ANNUAL MEMBERSHIP IS DUE EACH YEAR IN JANUARY. 

You can also purchase a Membership gift for a friend.  Just put on the check or form that it is a membership gift and please provide a name and address so the new members can get their newsletter.

Please check one:  YES      NO    Do Not Publish

If you would like to be listed, but do not want your phone number [or other items] published, please put Do Not Publish next to that item. If you do not want your name listed at all please check NO in the box above.

Download, print and mail form along with membership dues to: AIITCO, Twinbrook Station P.O. Box 775, Rockville, Maryland 20848. 

      Signature: