Viola da Gamba Society - New England
	Treasurer
	P.O. Box 192
	Belmont MA  02478
	USA

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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
 instead.)

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

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