MAIL TO:
Alliance Française de St. Louis 8505 Delmar Blvd. St. Louis, MO 63124
Membership Application
Membership Levels Please select one of the following membership levels:
Individual
$45.00
Angel
$250.00
Family
$70.00
Patron
$500.00
Benefactor
$125.00
Life
$2,500.00
Personal Information
Date:
Name:
Address:
City, State:
Zip code:
Home phone:
Work phone:
Mobile phone:
Email address:
If registering for a family membership, please list spouse and/or children's names:
Spouse:
Child:
How did you hear about us? Internet Radio Newspaper Friend/Word of Mouth Reputation
Payment
Amount enclosed:
Payment method:
Mastercard / Visa / Discover # ex (mm/yy)
Check #
Cash
*Amounts donated above the Individual or Family level may be tax deductible according to IRS guidelines.
Signature: