TASA Membership Registration Form

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 to 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, an Overseas Brats membership, and the Membership Directory.

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

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 ???___________________________________________________

Years in Iran and/or Attended TAS: ____________

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 can be intercepted by scrupulous individuals.

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!