South Bay Taiwanese Association (SBTA)
南 灣 台 灣 同 鄉 會

Membership Application/Update
Date: ____________
  Member Spouse (For couple membership only)
漢字姓名: ___________________________________ ___________________________________
English Name: ___________________________________ ___________________________________
Address: ____________________________________________________________________
      No. Street
  ____________________________________________________________________
      City State            Zip
Home Phones: ___________________________________  
Cell: (______)___________________________ (______)___________________________
Email: ______________________@____________ ______________________@____________
Annual Membership Fee (Non-refundable):
  ______ $20 (Couple)
  ______ $10 (Indivisual)
Or Permanent Membership Fee:
  ______ $200 (Couple - New membership)
  ______ $100 (Indivisual - New membership)
  ______ $180 (Couple - Renewal membership)
  ______ $90 (Indivisual - Renewal Membership)

The annual membership fee is $10 per each person.
You also may pay Permanent Membership Fee, the amount is listed above.


Please make your check payable to SBTA and send to:

Pishun Lin
1407 Mt. Shasta Ave.
Milpitas, CA 95035