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ARSIRN MEMBERSHIP APPLICATION FORM

Print out, fill in and fax to 239.261.9160
or mail to us:
c/o 1048 Goodlette-Frank Road Ste 201
Naples, FL 34102

Date Submitted: ______________________________

Name : _______________________________________________________

Street Address1: _____________________________________________

Street Address2: _____________________________________________

City, State, ZIP: ____________________________________________

Email: ______________________________

Day/Night Phone: _________________ /_________________________

ARSIRN has 3 levels of annual support; each includes a $35 donation to the Ayn Rand Center for Individual Rights (ARC).
Note: ARSIRN is a Florida registered not-for-profit corporation but is not an IRS 501c3.
A tax-deductable donation to ARC (the Ayn Rand Center) requiers a separate check.

Kindly deliver ARI's quarterly newsletter, IMPACT, by: ____ email ____ regular mail.

___ Supporter: $75 ($125 couples) Benefits include invitations to suppers and all non-fee events, discussion groups and meetings, a 20% discount on books from Books-A-Million and a one oz. copper medallion from a D’Anconia mine.

___ Sustainer: $175 ($225 couples) includes all Supporter benefits, plus free attendance at ARSIRN-sponsored events and a copy of the next quarterly issue of The Objective Standard for myself or a designee.

___ Benefactor: $275 ($350 couples) includes all Sustainer benefits plus invitations to private, limited-seating, Dutch-treat luncheons with Distinguished Scholars.

___ Students: $15 contribution to ARC plus volunteer work at ARSIRN functions as needed.
I attend (name of school): ________________________________________

Member Meeting Guest Fee: $15

___ I am already an annual contributor to ARI/ARC. Enclosed is my ARSIRN support for 2015.
___ I am not currently a contributor to ARI or ARC. Enclosed is my tax deductible check to the Ayn Rand Center for $_______ as well as my ARSIRN spport for 2015.

___ ASSOCIATE MEMBER (limited to 6 months): I am not ready to contribute to ARC but I would like to participate in ARSIRN activities as a member. Enclosed is $_____.___ to support ARSIRN.