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Japanese American Citizens League New York Chapter Membership Application Name: Address:  City   State    Zip Telephone:    Business Phone:   E-Mail Address: Fax Number: Please Indicate if: New Application Renewal Rejoin Student $25 Youth (25 & under) $25 Individual $65 Couple/Family  $110 1000 Club $100 Thousand Life Trust $3,000 (one-time payment) Century Club  $175.00 Century Life Club Trust $5,000.00 (one-time payment) 1000 Club or Century Club Spouse $35 Millennium Club $1,000 Spouse $40 CORPORATE MEMBERSHIPS: SILVER  $250.00 GOLD  $500.00 DIAMOND $1000.00 Please print out completed form and send with payment to: Ms. Lillian C. Kimura 75 Grove Street Bloomfield, NJ 07003-5641 Please make check payable to JACL For more information, e-mail: lckimura@att.net or Tel/Fax: 1-973-680-1441 We thank you for joining the New York Chapter JACL. There are chapter activities listed below that you may be interested in. We encourage your participation. Please indicate your choice(s): I am interested in participating in:   Speakers Bureau   Social Programs & Cultural Activities   Scholarship Committee  Finance/Investment Committee  Civil Rights Committee Student & Youth Activities Volunteer Activities Chapter & Advisory Board Membership Committee Other  (NY Chapter JACL 1/1/07)