WORLD COMMUNITIES OF LOUISVILLE, INC.

200 West Broadway, Suite 607

Louisville, KY 40202

(502) 561-5422

MEMBERSHIP APPLICATION - YEAR 20____

NAME (primary contact person):_____________________________________________

ORGANIZATION:__________________________________________________________

ADDRESS:_______________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

E-MAIL:__________________________________________________________________

TELEPHONE:___________________________ FAX:_____________________________

TYPE OF MEMBERSHIP:

____________INDIVIDUAL $15.00 /YEAR

____________FAMILY $30.00 / YEAR

____________EDUCATIONAL INSTITUTION $25.00 / YEAR

____________NON-PROFIT ORGANIZATION $35.00 /YEAR

____________CORPORATE $100.00 / YEAR

____________WORLD AMBASSADOR $1000.00

____________Donation:______________

AREAS OF INTEREST: 

____________ADVOCACY

____________EDUCATION

____________ECONOMIC DEVELOPMENT

____________FUNDRAISING

____________MEMBERSHIP

____________OTHER (please specify) ____________________________________________

Your dues are tax deductible.

Enclose Check or Money Order Payable To:

World Communities of Louisville, Inc.

Mail To:

World Communities of Louisville, Inc

200 West  Broadway - Suite 607

Louisville, KY  40202