CHEVALIER
THEATRE ORGAN SOCIETY
>>>
MEMBERSHIP DUES <<<
Date
__________________
Name__________________________________________
Address__________________________________________
_________________________________________________
_________________________________________________
Phone
___________________________________
Email ___________________________________
Dues: $10
single membership
$5
each additional member
of household
($25
maximum per household)
Annual
Dues
$_____________
Donation
(optional)
$_____________
Total
amount
enclosed
$
____________(tax deductible)
Make
check
payable to: Chevalier Theatre Organ Society
Send
to: Chevalier
Theatre Organ Society
Michael
Cerullo, Treasurer
P.O.
BOX 27
Medford
MA 02155-0001
Thank
you!