Country Dance Society, Boston Centre
                              P.M.B. 282
                      1770 Massachusetts Avenue
                          Cambridge MA 02140
                            (781) 662-6710
                         (781) 662-6730 (fax)

             M E M B E R S H I P   A P P L I C A T I O N



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Name(s)

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Address

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City, State, and Zip Code

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Day Phone (optional)                    Evening Phone (optional)

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Email address (optional)


___  New Member   OR   ___  Renewal


___ Do NOT list me/us in the Membership Directory

___ List me/us, but NOT my/our telephone number in the Membership Directory

___ List my/our email address in the Membership Directory

___ Do NOT include me/us in the list of donors

___ Do NOT share my/our name(s) and address with other, related 
    organizations for fundraising


MEMBERSHIP TYPE & RATES

    ___   $25   Regular (individual)

    ___   $10   Senior / Student / Low Income

    ___   $35   Contributor (family)  *

    ___   $45   Supporter  *

    ___   $60   Sponsor  *

    ___  $100   Patron  *

    ___  $500   Benefactor  *

* These memberships can include one or two adults, plus all children, at one address

    Membership amounts in excess of $10 per adult may be tax deductible.
    Additional tax-deductible contributions are appreciated.

    Please make checks payable to: CDS-Boston Centre

    Membership year ends August 31. 
    New members paying dues after April 30th will have their membership extended 
     through August of the following calendar year.


Please tell us what interests you (check all that apply):

    ___  English country dancing

    ___  American contra and square dancing

    ___  Morris and sword dancing

    ___  Volunteer opportunities

    ___  Other:  ______________________________________________________________


Membership Benefits Include:

    *Reduced admission fees at most of our events.
    *Newsletters, flyers, and notices mailed to your home.
    *Preferential admission to most pre-registration events.
    *Access to our book and record library.
    *Opportunity to participate in program planning and development.
    *Satisfaction of supporting a vital artistic/cultural/social non-profit 
     organization founded in 1915.