Toledo - Poznan Alliance Membership Application
   
To be directly involved, we invite you to become a member by sending in the information requested below with your membership contribution. Please print this page, fill in the blanks, attach your membership contribution and mail to:

Toledo-Poznan Alliance
P.O. Box 2555
Toledo, OH 43606

Senior Citizen/Student $5.00
Single Adult $10.00
Family $15.00
Small Bus./Non-Profit Org. $50.00
Corporation $150.00

Name:     ___________________________________
Address: ___________________________________
City:         ___________________________________
State:      _____________ Zip: ____________
Phone number: ________________________
Email Address: ______________________________