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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		$