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MEMBERSHIP FORM

If you are purchasing a membership as a gift, please follow these steps: 1. Select the gift membership from the membership list (there are two options: individual or family) 2. Enter YOUR personal information. 3. Enter the gift recipient's info at the bottom of this page. Please note: The recipient fields will not show up unless you select one of the two gift options. If you need additional assistance, email Karen directly at membership@larzanderson.org or call her at 617-522-6547 x18.

MEMBERSHIP LEVELS

Membership:

Individual - $60 - 1yr. (Personal)

Individual - $100 - 2 yr. (Personal)

Individual - $150 - 3 yr. (Personal)

Couple - $100 - 1yr. (Personal)

Couple - $175 - 2yr. (Personal)

Couple - $250 - 3yr. (Personal)

Family - $150 - 1yr. (Personal)

Family - $175 - 2yr. (Personal)

Family - $400 - 3yr. (Personal)

Sponsoring - $250 (Personal)

Patron - $750 (Personal)

Basic - $150 (Corporate)

Contributing - $300 (Corporate)

Corporate - $5,000 (Corporate)

Partner - $5,000 (Corporate)

Sustaining Membership - $100.00/Month (Personal)

Sustaining Membership $50/Month (Personal)

Sustaining Membership - $25/Month (Personal)

Sustaining Membership $10/Month (Personal)

Gift • Individual - $45

Gift • Family - $65

The membership you have selected will automatically renew.

PERSONAL INFORMATION

First Name: Last Name: Birth Date: / / Home Address: Address Line 2 City: State: Province (Foreign) Zip Code: - Zip Suffix Home Phone: Email:

GIFT MEMBERSHIP OPTIONS

Will only display if a gift membership is selected from the list above.

Additional Donation:

Recipient's Name:

Please enter the recipient's mailing information:

Please enter the recipient's email address:

Any special instructions? Including a gift note, date of mailing, etc.

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