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American Theatre Organ Society
P.O. Box 5327
Fullerton, CA 92838-0327
Membership Application

New Membership	Membership Renewal
Name
Address
City	State
Zip Code	Country
E-Mail Address
Phone	Fax
Type of Membership (All funds in U.S. Dollars)
Regular $40	Student (Under age 24) $25
Contributing $75	Sustaining $100
Patron $200	Benefactor $500
President's Circle $1,000
Life (includes lifetime membership benefit) $2,500
Membership outside the United States add $15
Optional Services
First Class Mail (U.S. Only) Add $15
Total Amout Enclosed $
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Type (select one) VISA MasterCard	Expiration Date (MM/YY)
Security Code (found in the signature line on the back of the card following the account number)
Card Number (no spaces or dashes)