La Crosse Scenic Bluffs Chapter – American Theatre Organ Society
Application for Membership
Name (Last, First)_____________________________________________
Home Address: _________________ Phone (home): ________________
_________________
City, State, Zip: _________________ ATOS Member?: Y ( ) N ( )*
E-mail Address: _______________________________________________
Membership level:
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Individual ($20) |
( ) |
Family ($20) |
( ) |
|
Donor ($50) |
( ) |
Sponsor ($ 100) |
( ) |
|
Mentor ($250) |
( ) |
||
|
Benefactor ($1000) |
( ) |
Student ($10) |
( ) |
Make Checks payable to:
La Crosse Scenic Bluffs Chapter, ATOS
Mail to:
La Crosse Scenic Bluffs Chapter, ATOS
C/O Michael Hengelsberg (President)
1616 Jackson Street
La Crosse, WI 54601
* Membership in ATOS is REQUIRED for voting privileges in chapter matters. See a member of the chapter for ATOS application.
