New Member
 
Renewing Member
 

Name:____________________________________________________

Institution: _________________________________________________

Address: __________________________________________________

City: _______________________

State/Province: _____________

Postal code: _________________

Country: __________________

Phone: _____________________

Fax: _____________________

E-mail: ____________________________________________________

Amount enclosed: $ ___________

Please circle category of membership or sponsorship
all contributions are tax deductible

Individual Memberships
Corporate & Individual Sponsors
$   18 — Students $   500 — Donor
$   36 — Annual $   2,000 — Sponsor
$   100 — Supporters $   5,000 — Patron
$   250 — Institutions $ 10,000 — Sustainer
    $ 20,000 — "Citizen-Soldier"
Please print and fill out this application,
and mail with your check payable to:

The Arthur Szyk Society
1200 Edgehill Drive
Burlingame, CA 94010

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