|
Name
Please include preferred title: (Mr., Ms., Mrs., etc.)
|
For Couple/Special Edition levels
or above: |
Spouse
Please include preferred title: (Mr., Ms., Mrs., etc.) |
| Street Address
City
|
|
State
Zip
Phone (please indicate day,
evening or cell)
|
| E-mail
Address (to be informed about upcoming events)
|
| Please check:
New Membership |
Renewing Membership |
If this is a gift membership, please complete the following
information for the recipient: |
|
Name
Please include preferred title: (Mr., Ms., Mrs.,
etc.) |
For Couple/Special Edition levels or
above: |
Spouse
Please include preferred title: (Mr., Ms., Mrs.,
etc.) |
| Street Address
City
|
| State
Zip
Phone (please
indicate day, evening or cell)
|
| E-mail Address (to
be informed about upcoming events)
|
Reason for purchasing a gift membership:
|
| Membership Level
|
|
Epic $1,000 and above |
Masterpiece $500 |
Classic $250 |
|
Bestseller $150 |
Novel (couples) $70 |
Bookworm (individuals) $40 |
Other Amount $
|
|
|
