ABATE of Iowa MEMBERSHIP APPLICATION
ABATE of Iowa, Inc.
P.O. Box 70
Eldora, Iowa 50627
1-515-858-5001

Full Membership Dues $20 / Year
Lifetime Membership Dues $300
Associate Membership Dues $15.00/Year
Supporting Business Dues $50/Year
Supporting Organization Dues $100/Year

It is suggested that applications be sent directly to the office.

Amount Enclosed__________________ Please send check or money order.

New Membership______ Renewal__________ Address Change ____________

Have you been a member of ABATE of Iowa in the past?___________________

New Full or Life Members Only would you like to recive a A.B.A.T.E. patch? yes__ no__

Please Print Legibly

District Number_________ Card Number___________________

Name ______________________________________________

Address_____________________________________________

City ____________________ State___________ Zip _________

County _______________________ Phone (_____)___________

Are you a registered voter? Yes _____ No ______

What is your Senate District number ? __ What is your House District number?___

Do you object to having $1.00 of your dues donated to ABATE PAC? Yes ____ No____

It is illegal to deposit money in a PAC from a corporate check. Please use personal checks.

New Member's Signature________________ Recruited by____________ Card No._____

Contributions or gifts to ABATE of Iowa are not tax deductible as charitable contributions,

however they may be deductible as ordinary or necessary business expense..

PLEASE PRINT THIS FORM, AND MAIL IT WITH A CHECK TO THE ADDRESS ABOVE. IF YOU HAVE ANY QUESTIONS, YOU CAN E-MAIL US AT Gillman2@yahoo.com