Membership Application Form

Name:                                                                                     Date:

Address:

City, State, Zip:

Phone & e-mail (H):

Phone & e-mail (W):

Comments:

Check appropriate box:   Student Membership $25.00   Individual Membership $60.00   Family Membership $100.00   Life membership $1000.00   Donation:

 
Please print out this form, fill it, and send it with a check made payable to:

Dante Alighieri Society of Massachusetts
Membership Application
41 Hampshire St.
Cambridge, MA 02139