321 East 69th Street New York, NY 10021 Tel. 212-717-1231 www.ChopinSocietyNY.org THE CHOPIN SOCIETY OF NEW YORK MEMBERSHIP APPLICATION Yes, I would like to join The Chopin Society of New York in the following category: Student $25 Associate $40 Friend $75 Patron $125 Sustaining $250 Other $_________ My contact information: Name ________________________________________________________ Address ______________________________________________________ City/State/Zip __________________________________________________ Email address _________________________________________________ Daytime Tel. ________________________________ Evening Tel. ________________________________ My check for $ ___________ is enclosed. All annual membership dues are tax-deductible. Please make checks payable to: The Chopin Society of New York Mail application form and payment to: The Chopin Society of New York th 321 East 69 Street New York, NY 10021 We thank you in advance for your support and we look forward to welcoming you as a member!
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