Membership Renew/Registration Form – 2015 Chinese Association of West Michigan (CAWM) 1. Primary Member Name (print): English

Chinese

2. If you are an existing member and have no change on member information, please go to item #6 3. Please check: a) New member b) New Address/Email/Phone

b) New Family Status

4. Address, email & telephone: Street: Home address City:

State:

Zip:

E-mail address* (CAWM Primary Communication Method) * Please provide other email addresses if more than one family members wish to receive CAWM group emails.

Home phone number Work phone number

Cell phone number(s)

5. Other family members: English

6. Please check membership type/dues: Family $ 35 Family without children $ 25

7. Member signature:

Chinese

Single member $15

Single college Student $10

_______________________________

Date: _________________

8. Payment received by: _______________________________

Date: _________________

- - - - - - - - - - - - - - - - - - - - cut here- - - - - - - - - - - - - - cut here- - - - - - - - - - - - - - - - - - - - - - - - - - - - - 9. Member Payment Receipt (keep this portion for your record) Member name: Paid Received by: ______________________________ $_________ Date: _________________ *You may include a check payable to “Chinese Association of West Michigan” or CAWM and mail it to: Zhongming Jiao, 5750 Sugarberry Dr. SE, Grand Rapids, MI 49512