Personal Information

	Name	Last Name
	Business Title
	Phone	Fax
	E-Mail
	Date of Application	Month January February March April May June July August September October November December   Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31   Year 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
	Signature

    Premium Membership ($2,000/year)
    General Membership ($650/year)
    Young Excutive Membership ($150/year, for ages 18-35 only)
    I would like to pay $ .............. as an additional one-time contribution to the Chamber
    Check enclosed
    Credit Card                                                         Amex Visa Master Card

		Card Number	Expiration Date   Month 01 02 03 04 05 06 07 08 09 10 11 12   Year 08 09 10 11 12 13 14 15 16 07 18 19 20 21 22 23
		Name
		Billing Address
		Signature
			Print Membership Form

    While contributions or gifts to the Turkish-American Chamber of Commerce & Industry are not tax-deductible as
     charitable contributions for federal income tax purposes, they may be tax-deductible under order provisions.