MEMBERSHIP FORM

(Print this form and mail to the following address)

The Gustav Mahler Society of New York

P.O. Box 1467, Old Chelsea Station, New York, NY 10113

___ I wish to become a Regular Member at $30 per year.

___ I wish to become a Student Member at $18 per year.

(School affiliation and ID#_______________________________________________)

___ I wish to become a Senior Citizen Member (65 or older) at $18 per year.

___ We wish to become Family Members (two people) at $50 per year; children up to 16 free.

___ I wish to become a Prime Donor at $50 per year.

___ I wish to become a Sponsor at $100 per year.

___ I wish to become a Patron at $500 per year.

___ I wish to become a Benefactor at $1,000 per year.

Name(s)________________________________________________________________________

Address_________________________________________________________________________

City_____________________________________State________________Zip________________

Telephone(s)___________________________Fax______________________E-Mail_____________