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" _______________________________________________________________________________ Name(s) _______________________________________________________________________________ Address _______________________________________________________________________________ City, State, and Zip Code _______________________________________________________________________________ Day Phone (optional) Evening Phone (optional) _______________________________________________________________________________ Email address (optional) MEMBERSHIP TYPE & RATES ___ $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.