Alliance Française de St. Louis 8505 Delmar Blvd. St. Louis, MO 63124
Membership Application
Membership Levels Please select one of the following membership levels. Any amount donated above the Individual or Family level membership is tax deductible.
Individual
$35.00
Angel
$200.00
Family
$50.00
Patron
$500.00
Donor
$70.00
Life
$2,500.00
Benefactor
$125.00
Personal Information
Date:
Name:
Address:
City, State:
Zip code:
Home phone:
Work phone:
Mobile phone:
Fax:
Email address:
If registering for a family membership, please list spouse and/or children's names:
Spouse:
Child:
Payment
Amount enclosed:
Membership term:
1 year 2 years
Payment method:
Mastercard # exp. (mm/yy)
Visa # exp. (mm/yy)
Check #
Cash
Signature: