Membership

(Please check One)

Distinguished Life Member     $250.00 _____

Member and Spouse             $ 40.00 _____

Member                               $ 25.00 _____

(_______________________Spouse's name)

NAME __________________________________

ADDRESS     ______________________________

                     ______________________________

                     ______________________________

TELEPHONE NO. (       )____________________

DATE__________________________________

 
_____ Yes, I am interrested in joining a committee of
The Pirandello Lyceum, and have indicated below
my preference(s). (Check as many as apply)

_____ Program Committee

_____ Financial Planning

_____ Academic Activities

_____ Public Relations and Membership

_____ Other (please explain)_________________________

_________________________________________________

Return this form with your check or money order to:

The Pirandello Lyceum
Post Office Box 458,
Wakefield, MA 01880.