Junius B. Booth Society, Inc.

MEMBERSHIP ENROLLMENT FORM

If you would like to be a founding member, print this page, fill out the following form and send to:

Junius B. Booth Society, Inc.
2515 Jerusalem Road
Joppa, MD 21085-1903 (Attention: Membership)

YOUR NAME: (For Society Records)	____________________________	DATE: ___________
STREET ADDRESS:	____________________________
TOWN:	__________________ STATE: _____	ZIP CODE: ___________
PHONE NUMBER:	___________________	E-MAIL: __________________

Basic Individual	______	$12.00
Basic Family	______	$15.00
Contributing	______	$25.00
Student	______	$5.00
Benefactor	______	$1,000.00

Please check or circle the category you have chosen and the amount you are paying. The dues cover membership for one year. Include a check payable to the Junius B. Booth Society, Inc.

The Junius B. Booth Society, Inc. is a 501(c)(3) nonprofit organization, donations to which are tax deductible to the fullest extent allowed by law. A copies of our current financial statements are available on our website: www.JuniusBooth.org. Documents and information submitted to the State of Maryland under the Charitable Solicitations Act are available from the Office of the Secretary of State for the cost of copying and postage.

The Society needs volunteers: founding newsletter writers, editors, a president, a secretary, a treasurer, artists, leaders, archeologists, etc. If you are interested in being a founding volunteer, contact us at JBBoothSoc@msn.com.

HOME: www.JuniusBooth.org