bm

Document Sample
bm Powered By Docstoc
					                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!