Brandeis National Committee - San Fernando Valley Chapter



Renewing  Membership

 


Renewing Membership | New Membership | Associate Membership | Getting Involved

 


BNC Membership Renewal Form

Ms Mrs. Mr. Dr. NAME______________________________________________AKA_______________
ADDRESS_____________________________________________________________
CITY____________________________________STATE______ ZIP_______________
HOME PHONE______________________________FAX________________________
EMAIL_______________________________________________________________
SPOUSE'S NAME_______________________________________________________

_____ Yes, I want to renew my membership in Brandeis National Committee for 2015-2016

Check one category:
    _____ Regular $ 60.00
    _____ Gold $ 85.00
    _____ Sustaining $125.00
    _____ Couples $100.00

Annual National dues apply from July 1, 2015 – June 30, 2016

Enclosed is my check for $__________.

Make checks payable to Brandeis National Committee [BNC]
REMEMBER: Dues are TAX DEDUCTIBLE

Or Charge my BNC membership dues of $_________________ to
      ___Visa       ___MasterCard          ___AmEx

Account number_______________________________________

Security No: ___________ Expiration date: __________

Signature: ________________________________________

SEND TO:
Membership K010
Brandeis National Committee
PO Box # 549110, Mailstop 132,
Waltham, MA 02454-9110
FAX: 781-736-4183

 

Please send information about the Brandeis National Committee to:

Name:______________________________________ (Mrs., Ms, Mr. Dr.)_____

Address: ________________________________________________________

City: ________________________ State: ________ Zip: _______________