First Name *  

Last Name *  

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State * ALAKAZARCACOCTDEDCFLGAHIIDILINIAKSKYLAMEMDMAMIMIMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY  Zip Code 

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E-mail  

The Council sends regular e-mail broadcast newsletters on upcoming programs, travel opportunities and membership benefits and reminders. Your recipient's e-mail address is important to us to insure that they are kept up to date on Council events and short-notice updates/advisories on programs. They will be automatically added to our e-mail subscriber list for this reason. However, if they do NOT wish to receive any e-mail from the Council, they may unsubscribe at any time by sending an e-mail to membership@wacphila.org.

Family Members' Names (if applicable): *Please indicate relationship

  I am a Young Professional between the ages of 21 and 35. Please send me information about Young Professionals events.

I wish to join at this level (please check one yearly fee): *Please select a Level

Individual (formerly Delegate) — $60
Dual (formerly Diplomat) — $100
Dual Plus (formerly Envoy) — $250
Ambassador — $500
Cabinet — $1000
Statesman — $2500
Premier — $5000
Superpower — $10,000

Click here to view all membership levels

You may prefer to print this form and mail it to the Council along with your credit card number or check.

Credit Card Type *   Visa
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SIC/"V" Code   Click here to view SIC/V location

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How did you initially find out about membership to the Council? *Please check one