ANNUAL MEMBERSHIP FORM

 Please complete form, print and mail with check, money order or bank draft in US Dollars to:

        Tahirih Association
          8306 Wilshire Blvd., Suite 70
        Beverly Hills, CA 90211  USA

 First Name
Last Name
Age (optional) Phone  
Sex      Male      Female
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
E-Mail
Please send information by      E-mail    Postal Mail

Annual Membership Levels (please select one):
Student $10         Senior $25        Contributor $35          Donor $50
Sponsor $100      Patron $500      Benefactor $1,000      Lifetime Member $5,000

I would like to purchase CDs to benefit The Tahirih Association:

A WOMAN AND HER WORDS     ___ (qty) @ $20.00 each (includes shipping & handling) = $ ________
SOLACE OF THE EYES                ___ (qty) @ $18.00 each (includes shipping & handling) = $ ________
Special Offer!  Both CDs               ___ (qty) @ $35.00 each (includes shipping & handling) = $ ________

Total  ENCLOSED.    .    .    .     .    .    .    .    .    .    .    .    .    .    .    .    .    .    .    .    .    .    .    .  = $ ________  

COMMENTS:

 

Copyright © 2000 [Tahirih Association]. All rights reserved.
Revised: March 02, 2001

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