Please print this form and return it with your check payable to the Barbara Pym Society to:
Ellen Miller, 145 Indian Hill Road, Carlisle, MA 01741.
Cut here ------------------------------------------------------------------------------------------------
Membership/Renewal for U.S. and Canadian residents
___ New membership ___ Renewal
___ Individual Membership $36.00
___ Family Membership (can be any two people at one address)
$50.00 ___ Senior Citizens (over 60)
$20.00 ___ Senior Family Membership (can be any two people over 60 at one address)
$30.00
Name
______________________________________________________________________________
Address
______________________________________________________________________________
City
__________________________________________________ ST _______ ZIP______________
Phone
( _____ ) ______-_________________ email _________________________________________
Check enclosed $ __________