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!