MBSID Number:Â
Please access the MBSI website (www.mbsi.org) – to edit your personal records. You can also renew in the members only section.
Name: __________________________________________________________________
Street: ___________________________________________________________________
City: ___________________________________________________________________
State: ___________________________________________________________________
ZIP: ___________________________________________________________________
Country: ___________________________________________________________________
Email:Â __________________________________________________________________
A prompt reply will maintain your membership and continue your MBSI publications without interruption.
SPECIAL OFFER: Purchase one or more gift memberships at $15 off the New Member’s first year’s dues (New member must not have been a member during the last three years). For each gift membership you purchase, you will receive a $5 discount on your next year’s dues.
Gift Membership Name(s)________________________________________________________________________
Address, City, State, Zip Code______________________________________________________________________
Phone:____________________ Fax:___________________E-mail:________________________________________
Please list additional gift memberships on a separate sheet.
MBSI MEMBERSHIP DUE TAX-DEDUCTIBLE DONATION
(A membership includes up to two adults and immediate family living in one household)
| $60 United States | $________ | Unrestricted General Fund | $________ | |
| $70 Canada or Mexico | $________ | Endowment Fund (promotes the purposes of MBSI) | $________ | |
| $75 Other International | $________ | Ralph Heintz Publications Fund (special projects) | $________ | |
| Optional Service (Additional) | Video Project (production of the MBSI DVD) | $________ | ||
| $20 Airmail (OUTSIDE US ONLY) | $________ | Museum Fund (supports museum operations) | $________ | |
#___ Gift Membership(s) X $45each | $________ | |||
| TOTAL MEMBERSHIP FEES | $________ | TOTAL DONATION | $________ |
GRAND TOTAL (Total Membership Fees + Total Donations) $_____________
______Check Enclosed We accept MasterCard, VISA or Am Exp___________________________________________________
Expiration Date(mm/yy)____________ Security code (follows the card # in the signature area on the back of card ___________
Signature______________________________________ Phone # REQUIRED_________________________________________
We also accept Paypal through the MBSI website or through paypal at www.paypal.com using email address jbeeman.mbsi@att.net