Membership is by calendar year.
Please indicate year of this enrollment:
New
Renewal
Type of membership:
Individual: $40.00
Family: $50.00
Contributing: $100.00
Supporting: $250.00
Life: $400.00
Donor: $500.00 (includes Life
membership)
Corporate Individual
Schools, Libraries and Organizations: $60.00
Student: $20.00
Chapter dues: $10.00 (in
addition to one of the above categories)
Please
indicate Chapter:
I wish to help the ALS with a contribution of: $
Name:
Profession:
Home
Address:
Street: Apt:
City State: Zip:
Work Address:
Organization:
Street: Suite:
City State: Zip:
I prefer to receive ALS mail at Home Work
Home Tel.:
Work Tel.:
Fax:
E-mail:
Make checks in US funds payable
to
American Liszt Society
Please fill
out, print and mail this form and your check
to:
Justin
Kolb
Executive/Membership
Secretary
Hog Mountain
Road
Fleischmanns, NY
12430
Tel:
(845)586-4457
E-mail: mellon@catskill.net
If convenient, please include a short professional resumé.
If you
wish to participate in activities of the Society, please indicate your
order of preference:
Performance
Paper
Presentation
Publish in JALS
Work to develop local Chapter activities
Host Concerts in the Home
About ALS