TASA Membership Registration Form

You will need to print this form and Mail or FAX it with your credit card information or check payable to TASA at the address at the end of this form.

If you haven't already, please renew or join TASA.

__ Standard ($15/Yr or __ $27/2 Yrs.)  Includes the TASA Newsletter with complete reunion photo & editorial coverage.

__Booster ($25/Yr or __$45/2 Yrs.)  Includes the above and an Overseas Brats membership.

__Patron ($40/Yr or __$75/2 Yrs.)  Includes all of the above and the semi-annual Class Reps/Patrons newsletters.

Personal Information Section

Last/Maiden Name:  ________________   Post-Maiden Name:  _________________

First Name:  _________________   Address:  _____________________________________

City:  __________________  State:  _________________  Zip:  ___________

Country:  ____________  Home Phone:  ________________  E-Mail:  __________________

Are you a former student, alumni, faculty member, or ???___________________________________________________

What years did you live in Iran: ______________

Class of _______(Former students or alumni: what year did you graduate from high school? It doesn't matter if this wasn't from TAS. This just gives a point of reference in what grades you were in at TAS only.)

Payment Section

Do Not Send Credit Card Information via Email - it's not secure and could be seen by cyber criminals.

For payment of membership, you can:

1) Mail a check or money order payable to TASA to:  TASA P.O. Box 47112 Wichita, KS 67201
2) Mail the following credit card information:
Name on card:___________________________  __VISA __MasterCard__Discover__American Express
Card # _____________________  Expiration date:_____________  Amount authorized: ______________________
3) Call or FAX in this information to (316-269-9610) between 7 a.m. and 7 p.m. CST.

Thank you again for your support!