Membership

We would like to invite you to become a member of Iran Alliance Task Force. This is a pre-requisite condition for any activities. Below is the form for you to fill out. After completion, you will be considered as a new member of Iran Alliance.

The purpose of the following questionnaire is to identify the talents/skills of our members so that we will better achieve Iran Alliance goals.
Members promise to abide by Iran Alliance rules of respecting other view points and not insulting others.

Your responses will be kept confidential. So answer as honestly as you can.
At Iran Alliance, we are interested in finding ways of reaching to more individuals constantly.

Thank you for taking the time to fill out this questionnaire.

- Membership committee

Name:

Address:

Phone:

Email:

Occupation:

Education:  Please Choose High School Graduate Some College College Degree Graduate Degree PhD / MD

---

How did you hear about Iran Alliance?:  Please Choose Website A Friend A Colleague Banner Advertisement

If you answered Banner or Website, which one?

Briefly mention why you wish to join the Iran Alliance:

With which of the following committees can you help us?

Committee for Resources Development (e.g., raising money)
Membership Committee (e.g., attract new members and
        maintain a database for members)
Public Relations Committee (e.g., news related to Iran Alliance, educating
        public, etc.)
Historical/geographical Committee (committee in charge of maps,
        historical documents, etc.)
Publication Committee (e.g., handling publishing the Iran Alliance magazine

Are you willing to support/establish a local/regional chapter? Please Choose Yes No

All donations received will go towards advertisement, publications, website development, and other related expenditures. If you would like to make a donation (any amount) to Iran Alliance, please state the amount and the check number and please send it to the following address:
    M. Ala (check or money order)
    Iran Alliance
    P.O. Box 3388
    Alhambra, CA 91803

Amount/CheckNumber:

Feel free to offer some ideas/comments.

Thank you.

Iran Alliance
www.iranalliance.org

To submit your questionnaire: