2009�2010 Lakeside Flutes Membership Form

You may use this form or a photocopy thereof to join as a new Performing Member, Sponsor or Benefactor, or to renew your membership at the same or increased level of support. Please mark the appropriate choices and fill in the requested information on the form. Then mail the filled out form with your donation (no cash please) to:

Lakeside Flutes, c/o Fran O'Connell, 828 Michigan, Evanston, IL 60202

___ New ___ Renewal ___ Change of Name, Address or Telephone Number

Membership Category, Donation:
Performing Member, $30.00; Sponsor, $20.00; Benefactor, $75.00; Corporate Contributor, $150.00 and above.

Name: Amount enclosed:

Street:

Telephone (day):

City: Telephone (evening):

State:

Zip Code:

Email: ____________________________________________________________________

Special Instructions: ________________________________________________________

Lakeside Flutes lists the names of its performing members, sponsors, and benefactors in its programs and newsletters as well as providing the above information in a membership list available to paid members of Lakeside Flutes for contact and networking purposes only.

Lakeside Flutes is a not-for-profit, tax-exempt organization.

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Name:		Amount enclosed:
Street:		Telephone (day):
City:		Telephone (evening):
State:		Zip Code: