TheTicknor Society
- a fellowship of book lovers -		 P.O. Box 380342
Cambridge, MA  02238

Membership Application

Annual dues are $25 per individual and run from January through December. Please print this form and include a check
(we cannot accept credit card payment at this time) made out to The Ticknor Society and send it to The Ticknor Society,
c/o Robin Bledsoe, 1640 Massachusetts Avenue, Cambridge, MA 02138.

Date:                                                        

Please check all that apply:

I am enclosing an additional tax-deductible
contribution of $ _______

My contact information has changed

Please check one:

New member $25 annually   Renewal $25 annually

Name:

Address:

City:      

State:    Zip:
Preferred phone   home   work   cell :
Preferred communication:      print    email    both
 Email:

Bibliophilic interest(s):

 

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Ticknor Society Home contact us Last modified: Wednesday, 02-Sep-2009 16:53:21 EDT