Name: ___________________________________________________________
Address: _________________________________________________________
Phone: ___________________ Email: __________________________________
Preferred method of contact (check one): ____Phone or ____ Email
____ Life Member ($1,000)
____ Pipes Partner ($500)
____ Key Contributor ($250)
____ In-Tune Member ($100)
____ General Membership ($25)
____ I cannot join right now, but please add me to your mailing list.
____Additional donation to help fund repairs to the Long Center Theatre Organ Society’s Mighty Wurlitzer! $ ________
TOTAL ENCLOSED: $___________
Mail this form and payment to: Long Center Theatre Organ Society, P.O. Box 177, Lafayette IN 47902-1077.
I am also interested in volunteering to help at concerts:
____ Usher
____ Ticket taking
____ Selling tickets
____ Sales table (Compact disks for sale)