Kansas City Athenaeum
Membership Application
Subject:
*
Active Individual - age 36 or over
Active Individual - age 35 or under
Active Household
Out-of-Town Member
Sustaining Member
Donor Member
Membership Activation Date
Name
*
Yearbook Entry preference -- ie: Smith, Jane (Mrs. John); Smith, Jane Brown (Ms)
*
E-mail Address:
*
Address
*
Phone: Home
Phone: Mobile
Birth Date (month/day)
Occupation(s) -- present & past
Interests
Affiliations
Referred by Club Member(s)
what do you expect/want from your membership?
*
Required
