MEMBERSHIP APPLICATION FORM SUMI-E SOCIETY OF AMERICA, Inc.
AMOUNT OF ANNUAL DUES:
Regular...................$40
Supporting................$70
Sustaining................$100
Sponsor..................$130
Patron...................$160
Student...................$23
Student must be new to this art, actively studying with a recognized
teacher, or enrolled in a university, college or a community program of
study. Limited to two years.


NAME ______________________________________________________________________
First----------Middle Initial----------Last

MAILING ADDRESS:___________________________________________________________
Street, Apartment No. or P. O. Box
City_________________________________ State ________ Zip Code __________________

TELEPHONE #______________________________ FAX #____________________________

E-mail Address ____________________________________________________________

CHAPTER AFFILIATION (if any)__________________________________________
(Chapter dues are separate from the National Dues.)

TYPE OF MAIL (please circle): First Class Third Class

If in USA territory and first class mail is desired, please add $10.
All members outside USA territory must add $15 for any mail.
Only one mailing address per member allowed.
All memberships expire December 31, each year.

Please make checks payable to:
Sumi-e Society of America, Inc.
Pay all fees in U.S. funds.

Please complete application form above and mail to:
Betty Nolan
Membership Secretary, SSA
122 Denton Street
Patchogue, NY, 11772