NETHERLANDS AMERICAN SOCIETY
OF SOUTHERN CALIFORNIA
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JOIN THE NETHERLANDS AMERICAN SOCIETY TODAY!

MEMBERSHIP APPLICATION
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* Type:
New Member
Renewal
Change of Address, Etc.
Please provide the following information:
Mr
Mrs
Ms

 
* First & Last Name

Birthdate
(mm/dd)
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&
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Occupations:
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* Telephone (At least one):
(H):
(B):
(C):
* E-mail:

* Address:

Address 2:
* City, State, Zip/Postal Code:
* Country:
Anniversary (mm/dd/yyyy):
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Introduced to NAS by:
Please send the NAS Newsletter:
Electronically (pdf) by email
As hardcopy by mail
Agreement:
 * As a new member, I agree to adhere to the rules and regulations as stated in the Bylaws of the Netherlands American Society.
* Date (mm/dd/yy):

The annual dues are $30.00 per person or $50.00 per couple payable by February 1st of the year.

New members admitted to the NAS after October 1 shall pay, for the remainder of the current year, $20.00 per person or $30.00 per couple.

After clicking the SUBMIT... button, please wait for the Thank You message which has a PayPal Pay Now button for making your dues payment. Your membership will not be active until payment has been received.
© 2017 Netherlands American Society of Southern California, Inc.