Membership Application for Major Institutions and Corporations

New Membership: _______                            Membership Renewal: __________

Membership Level:       President        ($10,000)  __________
                                        Ambassador   ($5,000)    __________
                                        Diplomat        ($2,000)    __________

*Name (Primary Designee)____________________________________________

Company_________________________________________________________

Mailing Address____________________________________________________

_____________________________________________Zip__________________

Phone______________ Fax______________ Email#__________________________

 ___  I want to help WorldBoston reduce its mailing costs.  Please send all correspondence via email.

*Please provide contact information for Primary Designee and attach contact information for

  for each Additional Designee on a separate sheet.

Payment: 

        ___    Check enclosed (made payable to WorldBoston)
        ___    Charge to MC / VISA / AMEX #_____________________________________
                                                                       Exp. Date ___/___/___

Membership          $________

**Contribution    $________

Total Enclosed    $________

**I understand that my member dues help defray the cost of providing member benefits. 

Therefore, I also wish to make a tax-deductible contribution to WorldBoston.          

Send checks to: 

WorldBoston

Attn: Membership

One Milk Street, 3rd Floor

Boston, MA 02109

Our Fax: (617) 423-7918 

Questions? Please contact  us at (617) 542-8995  or email  lgoldstein@worldboston.org