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JOIN THE AIS YOUTH

USE THIS FORM TO JOIN
(Fill out & Print this page. Mail the completed page with your dues)  
You may either print this as a blank page and fill it out by hand, 
or fill it out now, then print the completed page.

THIS PAGE DOES NOT SUBMIT ANY INFORMATION VIA INTERNET.  
IT IS FOR YOUR CONVENIENCE ONLY.

Name:  
Address:
City:
State: Zip:
Phone:  
E-mail:  

Membership Dues (Please CHECK "X" appropriate selection)
Single Annual $5.00    Single Triennial $9.00 
  Without AIS Bulletin    With AIS Bulletin
New Membership                  Renewal Membership 
 
Mail CHECK and FORM To:

 Tom Gormley
AIS Membership Secretary
10606 Timber Ridge Street
Dubuque, IA 52001-8268