2005 Mail-In ISS Membership Form

Membership must be renewed annually in January. For all but "Affiliate Members," paid membership brings an automatic subscription to the hardbound annual journal SHAW (retails at $42 in the U.S.), but to see a full list of benefits, click here. To renew your membership or become a member or give a membership, please print out this page, fill it in, and mail it with your check or money order (in U.S. dollars only) made out to “International Shaw Society” and addressed to: ISS, P. O. Box 728, Odessa, FL 33556-0728.

Check One:

This is a renewal of membership.

This is a new membership.

This is a gift membership (stipulate who the gift is from________________________). If you would like the ISS Executive Committee to pick the recipient of the gift, check this box:

This is an Affiliate Membership (to be eligible, you must be a verifiably paid-up member of another Shaw Society. You receive all benefits except the journal SHAW).

1. Annual Membership Fee. Circle whichever applies:

1A. Standard Fee Per Person: $40 U.S.

1B. Member & Spouse: $60 U.S.

1C. Student: $20 U.S.

1D. Affiliate: $15 U.S. (only for members verifiably of other Shaw Societies who do not wish to receive SHAW).

OR SELECT ONE OF THE FOLLOWING:

2. 2005 Contributor: Circle the amount you wish to give (includes membership fee): $75 $100 $125 $150

3. 2005 Sponsor: Circle the amount you wish to give (includes membership fee): $200 $250 $300 $400

4. 2005 Partner : Circle the amount you wish to give (includes membership fee): $500 More than $500 (please specify_____).

Your Total (tax deductible in U.S.):_________________ (Make check out to "International Shaw Society")

Your Printed or Typed Name(s):__________________________________________________________

Your Signature(s): ___________________________________________________________________

Date of Signing: _____________________

Street Address:______________________________________________________________________

Apartment # or Other Address Matter:____________________________________________________

City or Town: _______________________________________________________________________

State or Province or District:___________________________________________________________

Country:________________________________ ZIP or Other Mail Code:_______________________

Phone Number(s):____________________________________________________________________

Your Email Address(es). PLEASE NOTE: The ISS will be conducted more online than not, and it needs your email address(es) to make this possible and to cut costs. We urge you not only to give us your current email address(es), but to notify us whenever you change email address. Please list here current email address(es):________________________________

If you do not do email and need hard copy sent to your street address, please check this box:

Thank you for your membership and contribution.

Richard F. Dietrich

President of the ISS

Questions? Email dietrich@cas.usf.edu. Or call 813-920-2986.