Personal Information Name Phone (home) (work) Full address E-mail Occupation: Other interests and expertise: Today’s Date:
Please check one of the following: I have derived direct income in the last 12 months from teaching, hosting, sponsoring, selling, or otherwise being involved in a Tango or dance-related event of any type or selling of a dance-related product or service (Associate Member) I have not derived income from any of the sources above (Regular Member)
I prefer to receive my newsletter in the following form(s) (please check only those that apply) US Mail E-mail with full text of document E-mail only containing URL to web copy
I would like the following of my personal information withheld from directories distributed to members (check only if applicable): All information withheld (fully private listing) Home phone withheld Work phone withheld Postal addres withheld E-mail withheld
I am interested in the following Society-related activities (please check all that apply): Dances and milongas Classes and Seminars Assisting in a committee (newsletter, membership, events, publicity, etc.) Please indicate area of interest: Being a board member or committee chairperson
I am willing to have my name and mailing address provided or sold to (check one) Only organizations/providers of Tango-related events or products Tango-related and others the board may deem of interest to members No one!
Please fill out and print this form, and enclose your cheque for $10 (per person, if more than one person joining) to "The Tango Society of Boston, Inc." and mail to "The Tango Society of Boston, Inc., P.O. Box 390055, Cambridge, MA 02139-0055." (Memberships are processed immediately but mailed in batches, so please allow up to 30 days for receipt of your membership materials)
Cheque No. Amount enclosed
How did you find out about the society or where did you get this form?
For society use only