Renewing Membership

Brandeis National Committee - San Fernando Valley Chapter


BNC Membership Renewal Form

(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_______________________________________________________________
SPOUSE'S NAME_______________________________________________________

_____ Yes, I want to renew my membership in Brandeis National Committee for 2019-2020

Check one category:
    _____ Annual  $  60.00
    _____ Couples $100.00

Annual National dues apply from July 1, 2019 – June 30, 2020

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
415 South St. MS 122
Waltham, MA 02454-9110
FAX: 781-736-4118

IF YOU PREFER:
SEND TO:
Naomi Javitz
3541 Green Vista Dr.
Encino, CA 91436
(tel) 818-783-5419


- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

Please send information about the Brandeis National Committee to:

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

Address: ________________________________________________________

City: ________________________ State: ________ Zip: _______________



Brandeis National Committee - San Fernando Valley Chapter



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