Persia House Membership Application

Persia House is a nonprofit and nonpolitical organization for public benefit. Tax deductible contributions and donations to Persia House are the main source of our income. The membership is voluntary and consists of U.S. residents, 18 years of age or older, who desire to support the advancement of Persian community education. Persia House membership is $12 per year. Donations are appreciated.

Name: ______________________________ Date____________

Address: ___________________________________________

City: ___________________ State: ______ Zip: ___________

Phone: ___________________ E-mail: ___________________

Please write your check (Membership: $____Donation: $____Total: $_____)

payable to Persia House and mail it to the following address:

Persia House, PO Box 42033, Portland, OR 97242, USA

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