The Japan America Society of Vermont Dedicated to Improving Cultural Understanding and Business Interaction 29 Ethan Allen Avenue - Colchester, VT 05446 - U.S.A telephone : 802-655-4197 - email : info@jasv.org

Membership Application

Yes, I / we would like to join!

Name:

Street:

City, State, Zip:

Telephone:

Email:

Membership category:

[__]	Household/Individual ($25)
[__]	Non-profit organization ($25)
[__]	Senior Citizen (60+) ($10)
[__]	Student ($10)
[__]	Sponsor ($50)
[__]	Patron & Corporate ($100)
[__]	Life Time Membership ($1,000)

Employers will often match individual employee gifts. Will yours?

Please make your check (tax deductible) payable to the Japan-America Society of Vermont and send it to

Japan-America Society of Vermont
29 Ethan Allen Avenue
Colchester, VT 05446.

[__] Please send information on corporate membership.

[__] Please send membership information to the following person(s):

Thank you!