CHEVALIER
THEATRE ORGAN SOCIETY
>>>
MEMBERSHIP DUES <<<
Date __________________
Name__________________________________________
Address__________________________________________
_________________________________________________
_________________________________________________
Phone
___________________________________
Email ___________________________________
Dues: $10 single membership
$5 each additional member of household
($25 maximum per household)
Annual Dues $_____________
Donation (optional) $_____________
Total amount
enclosed $ ____________(tax
deductible)
Make check
payable to: Chevalier Theatre Organ Society
Send to: Chevalier
Theatre Organ Society
Michael Cerullo, Treasurer
P.O. BOX 27
Medford MA 02155-0001
Thank you!
