M E M B E R S H I P   A P P L I C A T I O N
              Country Dance Society, Boston Centre, Inc.
                         Membership Secretary
                 P.O. Box 3055, Acton, MA 01720-7055
              or e-mail: membership at cds-boston dot org
        CDS Office: (781) 591-2372   http://www.cds-boston.org
Please print, fill it out and return with your check made payable to: "CDS, Boston Centre"



City, State, and Zip Code

Day Phone (optional)                    Evening Phone (optional)

Email address (optional)


    ___   $35   Regular (individual)

    ___   $20   Senior / Student / Low Income (individual)

    ___   $35   Senior Family

    ___   $55   Contributor (family membership) *

    ___   $75   Sponsor (family) *

    ___  $100   Patron (family) *

    ___  $500   Benefactor (family) *

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

___ New Member   OR   ___ Renewal

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

Membership Directory preferences. Do you want to limit your personal information in 
 the directory? Check all that apply:

___ Do NOT list address(s)

___ Do NOT list phone number(s)

___ Do NOT list e-mail address(es)

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

___ English country dancing

___ American contra and square dancing

___ Morris and sword dancing

___ Other:  ______________________________________________________________

Membership Benefits Include:

*Reduced admission fees at most of our events.
*Newsletters, flyers, and notices mailed to your home.
*Preferential admission to most Boston Centre residential events at Pinewoods Camp.
*Free admission to the Annual Meeting and Dance.
*Opportunity to participate in program planning and development.
*Satisfaction of supporting a vital artistic/cultural/social non-profit organization founded in 1915.