Southeastern Historical Keyboard Society
2008 - 2009 Membership Application

Fill out this form, print it, and send it with a check payable in U.S. funds to : Southeastern Historical Keyboard Society

Send to:
Charles Mize, Treasurer
Southeastern Historical Keyboard Society
P. O. Box 677
Tesuque, NM 87574
Or, pay via PayPal: send payment to sehks@hotmail.com (add $5 service fee)
Name:
Address:
City/State/Zip or Postcode:
Country (if outside USA):
Home Phone:
Work Phone:
Cell Phone:
E-Mail:
Professional Affiliation :
Specialties:

Membership Types:
   Regular - $45.00$
   Student - $25.00$
   Institutional/Organization - $45.00$
   All Memberships Outside US Add Mailing Fee - $5.00$
   PayPal Service Fee (if paying by PayPal) - $5.00$

Contributions:
   Special contribution to Performance Competition, or General Fund $ 

Membership Options:
   Joint membership (Midwestern Historical Keyboard Society) - Additional $10.00 $
   Joint membership (Western Early Keyboard Association) - Additional $10.00      $
   Family (extra person, same address)Additional $10.00$
 
TOTAL FOR MEMBERSHIP    $

©2008 Southeastern Historical Keyboard Society