L'ALLIANCE FRANÇAISE DE KANSAS CITY

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MEMBERSHIP APPLICATION/RENEWAL (2001-2002) WITH ON-LINE ENROLLMENT OPTION

(September 1, 2001 through August 31, 2002)

Please indicate category of membership desired, or click on the shopping cart link next to category for on-line enrollment:

                                                 _____ Alliance Member $35.00 Add to my cart!

_____ Alliance Member  (more than 35 miles outside Kansas City, Mo.)  $25.00 Add to my cart!

                                                  _____ Alliance Family $45.00 Add to my cart!

_____ Alliance Family  (more than 35 miles outside Kansas City, Mo.)  $35.00 Add to my cart!

                                                  _____ Alliance Student $15.00 Add to my cart!

                                                  _____ Alliance Patron $150.00 Add to my cart!

                                                  _____ Alliance Friend $95.00 Add to my cart!

                                                   _____ Small Business $99.00 Add to my cart!

                                                   _____ Corporate $1,000.00 Add to my cart!

                                                  Amount Enclosed $_______ View Cart

In order to update our records, please include the following information:

LAST NAME___________________________FIRST  NAME_________________

Spouse's Name_______________________________________

STREET ADDRESS_________________________________________________________

CITY_________________________________ STATE________ ZIP______________

HOME PHONE_________WORK PHONE__________(AREACODE MANDATORY)

E-MAIL ADDRESS:__________________________

Circle One:  Check    VISA     MasterCard

Credit Card No. _________________________  Exp. Date: ______________  Name on Card:___________________________

Please Mail Payment To:

Alliance Française de Kansas City

P. O. Box 5947, Kansas City, MO 64111

[Fax Credit Card Payments to (816) 512-5099]

NO NEED TO FAX OR MAIL PAYMENT IF YOU USE ON-LINE ENROLLMENT