New Membership

Brandeis National Committee - San Fernando Valley Chapter


NEW MEMBERSHIP APPLICATION


Print page, fill it out, mail it
or download and print this .pdf


Ms Mrs. Mr. Dr. NAME______________________________________________AKA_______________
ADDRESS______________________________________________________________
CITY____________________________________STATE______ ZIP_______________
HOME PHONE______________________________FAX________________________
EMAIL_________________________________________________________________
CELL____________________________SPOUSE'S NAME______________________

_____Yes, I want to join Brandeis National Committee.

    Check one category:

_____ Regular $ 60.00
_____ Couples $100.00

Annual National dues apply from July 1 - June 30.

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: ________________________________________

For mailing information, contact:


Naomi Javitz
3541 Green Vista Dr.
Encino, CA 91436
818-783-5419
naomijavitz@brandeissfv.org

 

THANK YOU
for becoming a member of the Brandeis National Committee (BNC)
and for your contributions


Brandeis National Committee - San Fernando Valley Chapter



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