** VdGS-NE Membership Application Form **

Please print this form, fill in your information below and make your personal check, cashiers check, or money order payable to VdGS-NE (USA dollars only, please).

Mailing address:
	Viola da Gamba Society - New England
	P.O. Box 192
	Belmont MA  02478
Membership Dues are currently $15.00. Please note that VdGS-NE dues are payable on an academic year schedule (September through August). In addition, space has been provided on this form for any additional tax exempt donation you may wish to make to help the VdGS-NE and its work. - Thanks!
Questions about becoming a member, or your current member status can be directed to Membership@vdgsne.org

Please check one:  ___ New Member ___ Renewing Member

                   ___ I would like to help organize a workshop in my area!

Name:	     _______________________________________________________________________
Address:   _______________________________________________________________________
City:      ____________________________ State:  _____ Zip/Postal Code ____________

Telephone Numbers: _______________________________________________________________

E-Mail Address:    ____________________________________

Tax Deductible Donation:  _____________________________ 

Any additional information about yourself you would like to provide: _____________


(All newsletters, workshop announcements, flyers etc are available online at www.vdgsne.org or
 are sent by email.  Mark the following block if you wish to receive them by regular mail

____ Please send me newsletters, workshop flyers and other material by regular mail


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