New Membership: _______ Membership Renewal: _______
Individual ($100) ______ Family ($150) ______ Small Organization ($250)______
Student ______(Free Membership
available to all students who provide a copy of their current student ID.
Student members receive email
correspondence only.)
Name (Primary Designee)*: ____________________________________________________________________
Organization (for Small Organizations only)*: ______________________________________________________
Mailing Address: _____________________________________________________________________________
____________________________________________________________ Zip: _____________
Phone: _________________ Fax: __________________ Email: _______________________________________
___ I want to help WorldBoston reduce its mailing costs. Please send all correspondance via email.
*Please provide contact
information for Primary Designee and attach contact information for
each additional Designee on a separate sheet.
Payment:
__ Check enclosed (made payable to WorldBoston)
__ Charge my Visa / MasterCard /
AMEX:_____________________________________ Exp.: ___/___
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.