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Chinese Professional Club Membership Application/Renewal
 
 
    $100 Lifetime Single    $200 Lifetime Family*
 
    $10 Single Annual   $20 Family* Annual
 
    Renewal     Information Change  
 
* (Husband, Wife & Children under 18)
                 
                 
Salutation:  Mr.____ Mrs. ___ Ms. ___ Mr. & Mrs. ___ Dr.___ Drs.___  
 
  Dr. & Mrs. ___ Mr. & Dr. ___ Other ____    
 
Name(s):  
 
Address:                                           
 
City:  _______________________  State: _________ Zip Code: ___________________  
 
Telephone:   Home: Home Fax:
 
  Work: Work Fax:
 
E-mail Address:  
 
Profession(s):  
 
Referred
by:________________________________________________________________________________________
Please complete and remit this form & dues to: Irene Joe, 13038 Memorial Dr., Houston, TX 77079-7324. (Home phone & Fax: 713-464-4520; E-mail: hjj42@att.net)
Please make checks payable to:  Chinese Professional Club
 
AMOUNT ENCLOSED:   $  
 
 
CASH:  ______                        CHECK:  ______                             DATE PAID:  ____________________