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(Lost card replacement cost $10.00 - request must be made in writing)
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Check the appropriate words below:
New____ Renewal____
Individual ($35)___ Family ($60)____ (2 people at the same address)
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Information below will be used in our membership directory.
Please put an x next to any item you do not want included
Name:_________________________________________
Address:_______________________________________
City/State/Zip___________________________________
Day Phone: _______________ Evening Phone:_______________
E-mail________________
If you plan to participate in any workshops, you MUST include
your phone number and zip code.
Please write "membership" on your check and return
this completed form with your check to:
The Bead Society of Greater New York
P.O. Box 6219, FDR Station
New York, NY 10150
For Bead Society use: Date Check received: / /
Date sent Membership card / /
Date Lost Card Replacement / /
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