FOUNDATION FOR THE PRESEVATION, DISTRIBUTION

                AND CRITIQUE OF RARE MANUSCRIPTS, INC.

 

                                  Application for Membership*

 

 

Date: ___________      Name (Dr. /Mr. /Ms) ______________________________

 

Affiliation: __________________ Position: _______________________________

 

Address: ___________________________________________________________

 

                __________________________________________________________

 

                __________________________________________________________

 

 

                Check One: Home Address (   )                Office Address (   )

 

Telephone:                                                                 Other Information

Home: ______________________                          E-mail: _________________

Office:_____________________                             Fax: ___________________

 

Membership Dues:  ($50) _____      Additional Contribution: __________     

 

Comments:

 

 

 

  Would you please complete and return this application with your check to:

                 Dr. Homayoon Shidnia

                 Foundation for Rare Manuscripts

                 8515 Green Braes South Drive

                 Indianapolis, IN 46234-2929

                      

* Membership dues and other contributions to the foundation are deductible from Federal Income tax

Since the Foundation is a 501 (c) (3) organization.