JASNA Membership Form
Name ____________________________________________________________________
Address___________________________________________________________
City, State/Province, Zip______________________________________________
Primary Phone_______________________
Secondary Phone ________________________
Email Address ________________________
Membership category (student, individual, family,
etc.) _____________________
Please check all that apply:
__ New member
__ Renewal
__ Address change
__ Contribution
__ Gift membership from ___________________________
| Dues (refer to chart on prior page) | $_________ |
I also wish to make a contribution* to:
| JASNA or JASNA/Canada (circle one) | $_________ |
| Jane Austen-related Churches | $_________ |
| Jane Austen’s House | $_________ |
| Chawton House Library | $_________ |
| Total | $_________ |
* JASNA is a section 501(c)(3)
tax-exempt organization. US and International members contributing to JASNA or
the Austen sites listed above will receive a US charitable contribution tax
receipt. For Canadian tax purposes, contributions are deductible only if
designated for JASNA/Canada; a tax receipt will be issued for those donations.
Mail membership form and personal check or money
order, payable to JASNA in the appropriate currency, to:
|
U.S. and International
Membership Bobbie Gay
|
Canadian membership Nancy Stokes
|