Membership Application for Individuals, Families & Small Organizations

New Membership: _________                                          Membership Renewal: _________

Membership Levels:             

  Individual ($100) ______                                 Small Organization ($250) ______                    Family ($150) ______

  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 correspondence 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 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