Membership Form

YES! I want to join the
Southeast Michigan Returned Peace Corps Volunteers (SEMIRPCV)


Name________________________________________________

Address________________________________________________

Telephone Home________________ Work______________________

Country, years of service_____________________________________

Email Address:____________________________________________

Enclosed is:

  • $15 voting membership in SEMIRPCV

  • $15 associate membership (includes newsletter)

  • No money enclosed- I am a newly-returned volunteer and
    eligible for a free one-year readjustment subscription

  • $_______tax-deductible contribution to SEMIRPCV

  • Any Donation in addition would be appreciated.

  • All memberships are for one year.
    Return this form to:

    SEMIRPCV Treasurer
    PO Box 725075
    Berkley MI 48072