The Richard Wagner Society of the Upper Midwest

2009

Membership application and renewal form

Name(s):  _____________________________________________________________________

Street Address: ______________________________________________________________

City:______________________________     State: ________     Zip:____________________

E mail:   _____________________________            Home Phone: ______________________

Day Phone: ________________________
    
Fax: _____________________


Annual Membership classes (choose one):  
    Regular $45       Additional member at same address $35  
Student $15       Contributor $75       Sponsor $150        Benefactor $500  
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.

All dues and contributions are tax-deductible to the extent provided by law.
Please mail this form with
payment (in US Funds) to: 
Richard Wagner Society of the Upper Midwest
Membership
P O Box 3804
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 :



© 2008 by The Richard Wagner Society of the Upper Midwest