OCA, New York Chapter | Membership Form

	Embracing the Hopes and Aspirations of Asian Pacific Americans
NEW YORK CHAPTER
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Membership Form

Please complete this form and mail it along with your check payable to:
OCA - New York Chapter P.O. Box 3233 Church Street Station New York, NY 10008

Date: ____/____/________
Membership Status:
		New member
		Renewing member
First Name: ________________________________________
Last Name: ________________________________________
Street Address: ________________________________________
City, State, Zipcode: ________________________________________
Telephone:
	Work: (______) ______-________
	Home: (______) ______-________
	Fax: (______) ______-________
E-mail Address: ________________________________________
Occupation: ________________________________________
If married,
	Spouse's Name: ________________________________________
	Spouses's Occupation: ________________________________________
Membership Level:
		Individual ($25)
		Student ($10)
		Family ($45)
		Business ($100)
		Benefactor ($500)
I would like to make an Additional Contribution of: $________.00. Thank you!

OCA is a 501(c)(3) non-profit organization. Contributions are tax deductible to the extent permitted by law.

OCA, "Embracing the Hopes and Aspirations of Asian Pacific Americans."

Copyright © 2005-2008 OCA-NY and others. All rights reserved.
OCA-New York, P.O. Box 3233, Church Street Station, New York, NY 10008
OCA is a 501(c)(3) non-profit organization. Contributions are tax deductible to the extent permitted by law.