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Member Form 2012 Filipino-American Association of Greater Atlanta Inc. ESTABLISHED 1974 www. atl-filam.org DATE NEW MEMBER RENEWING FAMILY 25 INDIVIDUAL 15 STUDENT 18-25 5 FAMILY is defined as the HUSBAND and WIFE and all CHILDREN under the age of 18 yrs. including all SENIOR household members. Fil-Am SENIORS are defined as the parents or in-laws and are qualified dependents of the head of the family. Please return with check payable to FIL-AM ATLANTA to Lolit Elliott Fil-Am Atlanta 6609 Brynhurst Dr. Tucker GA 30084 Fil-Am Atlanta is a not-for-profit but not a 501c 3 tax-exempt organization May we include your contact information in the Fil-Am directory. We use your contact info ONLY for Fil-Am purposes. We never use members contact information for any other purpose. Circle one YES NO Your Initials PERSONAL INFORMATION FIRST NAME NICKNAME LAST NAME BIRTHDATE SPOUSE S NAME WEDDING DATE ADDRESS CITY ZIP CODE CELL PHONE HOME PHONE HOME E-MAIL ADDRESS OTHER E-MAIL ADDRESS HOME TOWN IN THE PHILIPPINES HOME PROVINCE IN THE PHILIPPINES CHILDREN UNDER 18 SENIOR HOUSEHOLD MEMBERS children over 18 must please join separately NAME SCHOOL GRADE AREAS OF INTEREST Website/Publicity Culture Committee Fundraising Drives Sports/Outdoors Social Committee Service Committee Membership Committee Finance/Accounting FOR FIL-AM USE ONLY Officer Receiving Payment Fil-Am Form FA-A01 revised 2012 Date Payment Check No* or Notes. including all SENIOR household members. Fil-Am SENIORS are defined as the parents or in-laws and are qualified dependents of the head of the family. Please return with check payable to FIL-AM ATLANTA to Lolit Elliott Fil-Am Atlanta 6609 Brynhurst Dr. Please return with check payable to FIL-AM ATLANTA to Lolit Elliott Fil-Am Atlanta 6609 Brynhurst Dr. Tucker GA 30084 Fil-Am Atlanta is a not-for-profit but not a 501c 3 tax-exempt organization May we include your contact information in the Fil-Am directory. Tucker GA 30084 Fil-Am Atlanta is a not-for-profit but not a 501c 3 tax-exempt organization May we include your contact information in the Fil-Am directory. We use your contact info ONLY for Fil-Am purposes. We never use members contact information for any other purpose. We use your contact info ONLY for Fil-Am purposes. We never use members contact information for any other purpose. Circle one YES NO Your Initials PERSONAL INFORMATION FIRST NAME NICKNAME LAST NAME BIRTHDATE SPOUSE S NAME WEDDING DATE ADDRESS CITY ZIP CODE CELL PHONE HOME PHONE HOME E-MAIL ADDRESS OTHER E-MAIL ADDRESS HOME TOWN IN THE PHILIPPINES HOME PROVINCE IN THE PHILIPPINES CHILDREN UNDER 18 SENIOR HOUSEHOLD MEMBERS children over 18 must please join separately NAME SCHOOL GRADE AREAS OF INTEREST Website/Publicity Culture Committee Fundraising Drives Sports/Outdoors Social Committee Service Committee Membership Committee Finance/Accounting FOR FIL-AM USE ONLY Officer Receiving Payment Fil-Am Form FA-A01 revised 2012 Date Payment Check No* or Notes. including all SENIOR household members. Fil-Am SENIORS are defined as the parents or in-laws and are qualified dependents of the head of the family. Please return with check payable to FIL-AM ATLANTA to Lolit Elliott Fil-Am Atlanta 6609 Brynhurst Dr. Tucker GA 30084 Fil-Am Atlanta is a not-for-profit but not a 501c 3 tax-exempt organization May we include your contact information in the Fil-Am directory.

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