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Your Name: ____________________________________________________________________________ Address:_______________________________________________________________________________ City_____________________________State________Zip____________Country_______________________ Telephone__________________________________Email_________________________________________ ____$ 25.00 CHARTER MEMBERSHIP in the name above (or if you prefer) ___________Anonymous ____$ 25.00 IN MEMORY of ________________________________________________________ ____$ 25.00 IN HONOR of ___________________________________________________________ Notes: __________________________________________________________________________
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_______ Cash (via registered mail) __________ Check __________ Money Order
Questions? Contact....Mr. Harvey Abrams, President, IISOH -- HAbrams@iisoh.org |
All donations over $25.00 receive Lifetime recognition.
All donations over $250.00 will receive additional recognition such as
engraved bricks, plaques, etc., in accordance with the approval of the Board of Directors.
April 22, 2013 Revised December 25, 2013 Revised August 4, 2014 Revised November 1, 2015 iisoh040 |