I am interested in your organization. Here is my personal information:
Name: Street address:
City: State and Zip Code:

Day phone:

Night phone:

Occupation:

Hobbies/Skills:

Spouse/Partner:

Spouse Occuption:
e-mail address: Birthday:

Please tell us how you would like to be involved:

Hosting a Brazilian adult on a Partners Project (usually 5 - 7 days)
Hosting a Brazilian Youth Ambassador (2 months in February and March)
Hosting a Partners event (meeting, party, etc.)
Transporting/helping Brazilian visitors in my community.
Helping to plan Partnership visits for Brazilians (itineraries, locating resources, etc.) between cities
Planning a Youth Ambassador's visit (finding host families, talking to schools, seeking applicants for travel to Brazil,etc.)
Translating written materials. Portuguese>English; English>Portuguese.
Being an interpreter for a visitor.
Travel to Rio Grande do Sul, Brazil, on a Partners project.
Assist with a cultural or food event demonstrating Riograndense culture.
Make a presentation or host a booth about Partners.

Use the box below to send us your comments, questions, etc., about matters not covered above.
Membership LevelsPayment Instructions
Sponsor$1,000 Print Form and mail with check payable to
Patron$500Indiana Partners of the Americas
Subscriber$250to: Hal Roepke, 4806 W University Ave, Muncie IN 47304
Contributor$100
Family$40To pay by credit card
Individual$25TO BE COMPLETED
Student$5
To send the Form by e-mail, click "Print", then click "Save as PDF". Then attach "Information Form.pdf" to an e-mail mesasage.
General guestions e-mail: Jhani Laupus, President For Membership questions e-mail: Rick Bein, Membership VP