JASNA Membership Form
Name ____________________________________________________________________
Second Name (if family membership)___________________________________________
Address__________________________________________________________________
City, State/Province, Zip_____________________________________________________
Primary Phone______________________ Secondary Phone ________________________
Email Address ____________________________________________________________
Membership category: __Individual __Student __Family __Sustaining __Life __Convert to Family Life __Family Life
Please check all that apply:
___ New member
___ Renewal
___ Address change
___ Contribution
___ This is a gift; please send the member a gift card 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 | $______________ |
| 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
|