[ ]
SCANDINAVIA HOUSE ASSOCIATE $50
[ ] FAMILY ASSOCIATE $65
[ ] CONTRIBUTING ASSOCIATE $150
[ ] SUPPORTING ASSOCIATE $300
[ ] SUSTAINING ASSOCIATE $500
[ ] PATRON $1,000
[ ] PRESIDENT'S CIRCLE $2,500
[ ] NATIONAL/INTERNATIONAL ASSOCIATE $35
[ ] SENIOR/STUDENT ASSOCIATE $25
I'd
like to join at the membership level indicated above. My check or
money order for $_________ , payable to The
American-Scandinavian Foundation, is enclosed. For payment
by credit card, please enter required information
below.
MR./MRS./MS.
NAME
________________________________________________________
ADDRESS______________________________________________________
_________________________________________ZIP
_________________
PHONE _________________________EMAIL__________________________
Special interests (circle all that apply): Denmark,
Finland, Iceland, Norway, Sweden
I'd like to purchase a gift membership for a friend:
MR./MRS./MS.
NAME
________________________________________________________
ADDRESS__________________________________ZIP_________________
_____________________________________________________________
GIFT MEMBERSHIP LEVEL ________________________________________
In
addition to my membership fee, I am enclosing a tax-deductible
contribution of $________ to further support the ASF's
work.
CREDIT CARD INFORMATION:
Please circle: VISA/MC/AMEX
Card Number ____________________________________ Expiration date ________________
Cardholder's Signature __________________________________________________________
SEND COMPLETED FORM TO:
The
American-Scandinavian Foundation
at Scandinavia House
58 Park Avenue
New York, NY 10016
ANY QUESTIONS? Contact our Membership Department at (212)
879-9779, or email: mem@amscan.org