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MEMBERSHIP FORM

Print and return this form with your payment to:

The Dante Alighieri Society of Santa Cruz
P.O. Box 4253
Santa Cruz, CA 95063

Date _______________________

Ms./Mrs./Mr./Dr.___________________________________________________

Business___________________________________________________________

Address___________________________________________________________

City _____________________________________________ Zip____________

Tel. # (h) _______________________ Tel. # (w) _________________________

E-mail___________________________________________________________

Please pick a membership category:

__ Full time student $10
__ Senior (60 +) $25
__ Individual $30
__ Family $50
__ Business membership $100
__ Life time membership $500

__ Additional Donation $________
The Dante Alighieri Society of Santa Cruz is a 501(c)(3) corporation

AMOUNT ENCLOSED $ ________________
(Make checks payable to Dante Alighieri Society of Santa Cruz)

How did you hear about us? __________________________________

Are you interested in becoming a volunteer for Dante Santa Cruz? If so, check one of the following:
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