Application for State Association for the Preservation of Iowa Cemeteries

SAPIC MEMBERSHIP APPLICATION
SAPIC is a non-profit organization 501 (c) (3). Contributions are deductible
under sections 170, 2055, 2106 or 2522 of the Internal Revenue Code.

Date: _________________ New Membership: _________ Renewal: __________

Name ________________________________________________________________

Address ______________________________________________________________

City ___________________________ State: ______ Zip Code (+4) _____________

Telephone: __________________ E-mail: _________________________________

(Please check)

Individual $10: _______ Family $15: _______ Lifetime Individual $100: _______

Business $20: _______ Organization $20: _______

DONATION or MEMORIAL: $ _________________

List names of honoree(s) if desired: ________________________________________

MAIL TO:

SAPIC c/o Valerie Ogren
108 N. Oak St.
Jefferson, IA 50129