Super Donor Membership Form

Date

MonthDayYear
Date
Super Donor Membership
Name*

First NameLast Name
E-mail
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Birth Month (optional)
Please select:

Printed newsletter delivered via USPS mailElectronic newsletter delivered via email. Be IAHF Green! Save money, save trees!Delivered via USPS mail and email
Each year we produce a membership directory which is distributed ONLY to IAHF members. Inclusion of your name, phone number and email address is automatic. We never publish your street address. If you would like to be excluded, or have some of your information excluded, please indicate below:
Exclude ALL my informationExclude my phone numberExclude my email address
If you would like to volunteer, please click the buttons below:

FestaCooking HelpBuilding RepairsOffice/Computer workMarketing
Optional: Please include name of spouse or partner if applicable.

First NameLast Name
Birth Month of Spouse/parther (optional)
Emergency Contact Name
Anniversary Month and Day
Emergency Contact Number

Choose Membership Level*

Da Vinci$250.00

Medici$500.00

Montessori$1,000.00

La Dolce Vita -- Lifetime membership$3,000.00

I would like to add $15 extra to cover the cost of newsletter printing and mailing$15.00

Total $0.00

Payment Method

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