Please fill out this form, print and send it with your check to
Westchester Filipino American Society, Inc.
73 Radford Street, Yonkers New York 10705

Name: ________________________________

Address: ________________________________

City: ________________________________

State: ________________________________

Zip Code: ______________________________

Enclosed is the membership fee for my family

______________ Annual membership fee of $20.00

______________ Lifetime membership fee of $250.00

____________________________ ________________
Signature Date

If you want to serve as an officer / member in the committee,
Please check below;

______________ Membership committee

______________Fundraising committee

______________Press release committee

_____________ Newsletter

_____________ Scholarship committee

_____________ Choral group

_____________ Dance group

_____________ Games committee