Please fill in the form below and print this page, then mail it together with your payment to:

If you prefer, you can download a PDF Version of the application.

We look forward to hearing from you!

I wish to become a member of the Wilhelm Furtwängler Society of America.

Membership dues are $25 per year for U.S. residents and
$30 per year for Canadian and International residents, payable in U.S. dollars to:
"The Wilhelm Furtwängler Society of America"

I have enclosed membership dues in the form of:
Check     Money Order VISA Mastercard
Name:
Address:
City:		State:   ZipCode:
Country:
Visa or Mastercard #
Expiration		Month/Year (00/00)
Signature		x __________________________________________________