The US-Azerbaijan Council Membership Benefits
1. Silver membership

Corporate $3,000.00 per year, Academic and Non-profit organizations $900.00, Individuals $500.00

Benefits:



2. Gold membership Benefits:

3. Platinum Membership

Application Form

If you would like to become a member of The US-Azerbaijan Council, please
fill out the form, enclose payment and mail.

Name/Company Name:______________________________________________________

Address:_________________________________________________________________

Telephone:

Fax:

E-mail:

Payment of  $____________

Enclosed:

o Check

Charge:

o American Express
o Visa
o MasterCard

Card Number: ____________________________________

Expiration Date:______________

Name (as appears on card):___________________________________

Authorized signature: ________________________________________


PLEASE SEND THIS FORM WITH PAYMENT TO THE US-AZERBAIJAN COUNCIL
The US-Azerbaijan Council
1010 Vermont Avenue, NW Suite 814
      Washington, DC 20005
        Tel: (202) 662-1343
        Fax: (202) 663-1353