Patron.........................................................$200.00 and up
Sustaining contributor (Annual Dues)....$100.00
Member (Annual Dues)............................$50.00
Please make your contribution payable to the Society for Advanced Study. In the memo line of your check please note: Account # 37-RGD3-01-6 Income.
OTHER CONTRIBUTION CATEGORIES
Herman B Wells Distinguished Lecture Fund , Account # 37-RGD3-03-2
Institute for Advanced Study Building Fund , Account # 38-RGD3-01-4
All contributions are tax deductible. For accounting purposes, please send separate checks for dues and other contribution categories. All contributions should be sent directly to:
Society for Advanced Study, The Poplars 335, Indiana University, 400 East Seventh Street, Bloomington, Indiana 47405
Please feel free to write us at any time or phone us at (812) 855-1513. We are most grateful for your continuing support.
SAS Membership : Patron______ Sustaining ______ Member ______
Contribution: $_____________________________
Other contributions:
Herman B Wells Distinguished Lecture Fund $_______________________
Institute for Advanced Study Building Fund $________________________
Name and Address: ______________________________
______________________________
______________________________
E-mail address: ______________________________
Phone number: ______________________________
Date: ______________________________
Your comments are welcome:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Thank you very much!
Printable PDF form with computer entry forms
