The Richard Wagner Society of the Upper Midwest

2008

Membership application and renewal form

Name:  _____________________________________________________________________

Street Address: ______________________________________________________________

City:______________________________     State: ________     Zip:____________________

E mail:   _____________________________            Home Phone: ______________________

Day Phone: ________________________
    
Fax: _____________________

Name and address as you wish it to appear in the Directory This will not be published on the internet. (Leave blank if you wish):


Annual Membership classes (choose one):     regular $45.00       student $15.00
Contributor: $75.00      Sponsor $150.00        Benefactor: $500.00   
Additional contribution for the Performing Wagner fund:   ____________
  
For further information call 612-863-4319.
Please make checks payable to
The Wagner Society of the Upper Midwest.
You may print this form and mail with
payment (in US Funds) to: 

Richard Wagner Society of the Upper Midwest.
Membership
P O Box 300014
Minneapolis MN 55403
  
 Please tell us how you heard about us:

Please add comments or suggestions about programs and activities, or areas in which you would like to volunteer :



© 2006 by The Richard Wagner Society of the Upper Midwest