HOME
ABOUT SERTOMA
MISSION STATEMENT
HISTORY
SERVICES
SCHOLARSHIP WINNERS
LOCAL SERVICES
NATIONAL SERVICES
BECOME A MEMBER
CONTACT
HOME
ABOUT SERTOMA
– MISSION STATEMENT
– HISTORY
SERVICES
– SCHOLARSHIP WINNERS
– LOCAL SERVICES
– NATIONAL SERVICES
BECOME A MEMBER
CONTACT
BECOME A MEMBER
Joining the Cedar Valley Sertoma Club is easy!
Simply fill out the form below. Membership is $38.75 every three months which includes your local and national dues.
Company
Member Information Form
Club #:
Club Name:
District:
Region:
Signature of individual completing form:
*
Date:
*
Please select one of the following:
Add Member
Life Member
Corporate Member
New Member
Rejoining Club
Transfer Member
Delete Member
Deceased
Moved
Non-Payment of Dues
Other
Change Member Information
Member ID#:
Surname
*
Dr.
Mr.
Mrs.
Ms.
Miss
Name
*
Nickname
Preferred Mailing Address:
Home
Work
Email Address
*
Street Address
*
City, State, Zip
*
Home Phone
*
Employer
Job Title
Work Address
City, State, Zip
Work Phone
Work Fax
Date of Birth
Spouse
New Member Signature, by typing your name below you are requesting to become a member of Cedar Valley Sertoma Club:
*
Date:
*
