Renewal Form - Aksarben Foundation

Thank you for renewing your membership with the Aksarben Floor Committee! To keep our records up to date, please complete and submit the information below.

Member Name(Required)

First Last

Goes by:

Spouse's Name

First Last

Spouse Goes by:

Address(Required)

City State ZIP Code

Home Phone

Cell Phone(Required)

Business Name(Required)

Current Title(Required)

Business Address(Required)

Street Address City State ZIP Code

Business Phone

Email(Required)

Present Age(Required)

Please enter a number less than or equal to 90.

Volunteer Involvement (Organization / Current volunteer position / # Years involved)

Family Information (Child’s First Name / Child’s Last Name / Gender / Date of Birth (MM/DD/YY) / Current School and Grade

Information is used for potential nomination for pages, standard bearers, princesses and escorts

Dues of $1,000 are due within 30 days of membership being accepted. You can pay online or an invoice will be sent. As the Floor Committee works to expand and diversify its membership across backgrounds, geographies and industries (including the public and nonprofit sectors), we have a scholarship available to cover dues for up to 10% of members. Please indicate if you'd like to be considered for a scholarship with any supporting information you'd like to provide. Scholarships are limited and will be awarded at the Aksarben Foundation's discretion by April 1.

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