Registration Form:

Friends of Benin                   National Peace Corps Association (NPCA)
___New                                 ___New
___Renewal                          ___Renewal     

                                                                                                                
Name:________________________   

                                                                                                                               
Street Address:_____________________________  

                                                                                                       
City, State, Zip:____________________________     

                                                                                                      
Telephone: Home_________________Work____________________           

                                                                  
Email:________________________             

                                                                                                                     
Current Employer:__________________________          

                                                                                                  
Current Occupation:________________________         

                                                                                                   
Peace Corps Job:___________________________        

                                                                                                  
PC Country:________________Years of service:__________

 ___Associate members - I am not an RPCV nor RPCS
I am interested in: ____________________

Select one membership category:
___Newly returned RPCV - 6 months free
___$50 NPCA/FOB dues (this is fixed by NPCA and can't be changed!)
___$65 Family NPCA & FOB
___$15 FOB Only (1 year)
___$22.50 Family FOB (1 year)       

 ___$135/individual three-year (NPCA and FOB)
___$180/family three year  (NPCA and FOB)
 

Additional contributions for NPCA:
___$1000 Director's Circle
___$500 Patron
___$250 Leadership Club
___$100 Sustaining
___$10 Overseas Mail
$____TOTAL AMOUNT

Make check payable to Friends of Benin and send to our treasurer: 

Elizabeth Whalen  

1212 Park Rd.

Washington DC 20010

 so you can get on the mailing list for the next Deadbeat issue (published quarterly more or less), become an official member and support FOB.  Membership begins on the date in which payment is received and ends one year later.  A reminder will be sent before your membership expires.   Please encourage your fellow non-member Benin RPCV’s to join.   

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