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Membership Information New Member Renewal annual renewal date is September 30
Type of Membership Individual $15 Student $5 Organization $30 Sustaining $50 Contributing $100
Personal Data
Name Address City State Zip Code Occupation Business/School Name Work Phone Personal Phone FAX email address
Student Scholarship Donation Yes, I wish to donate Amount $
Application & Mailing Information Print and Mail this membership form with payment to Jean Montgomery 4544 18th Avenue South Minneapolis, MN 55407 Total amount enclosed $ Make checks payable to NBS / USITT