Prefix: * First Name (as it appears on passport)

* Middle Name (as it appears on passport):

* Last Name (as it appears on passport):

* Job Position/Title: Organization/Affiliation:

Address: *

Address 2:

* City:

* State:

* Country:

* Zip/Postal Code:

* Phone (Include area code):

* Additional phone numbers (office and/or cell):

Fax (Include area code):

E-mail: *

Confirm E-mail: *

* Preferred name for name badge:

* Travel Companion Information :

  Prefix: First Name (as it appears on passport):

Middle Name (as it appears on passport):

Last Name (as it appears on passport):

Job Position/Title: Organization/Affiliation:

Address:

Address 2:

City:

State:

Country:

Zip/Postal Code:

Phone (Include area code):

Additional phone numbers (office and/or cell):

Fax (Include area code):

E-mail:

Confirm E-mail:

Preferred name for name badge:

* Delegates must be members of Fort Worth Sister Cities.

Please include your membership fee with your non-refundable deposit based on the following:

Yes, I am a current member $40.00 Educator/Senior Add $10.00 for spouse

$50.00 Individual Add $10.00 for spouse

PAYMENT OPTIONS: Payment Type: *   Total Due: *   Please Note: If you pay by credit card, your card will be billed by Fort Worth Sister Cities International and a 3% processing fee will be added. Privacy Statement: Your name and information will not be provided to any outside vendors.

• Check number:

• Money Order (Make checks and money orders payable to Sister Fort Worth Sister Cities International)