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Ms Mrs. Mr. Dr. NAME______________________________________________AKA_______________
ADDRESS______________________________________________________________
CITY____________________________________STATE______ ZIP_______________
HOME PHONE______________________________FAX________________________
EMAIL_________________________________________________________________
CELL____________________________SPOUSE'S NAME______________________
Check one category:
_____ Regular | $ 60.00 |
_____ Couples | $100.00 |
Annual National dues apply from July 1 - June 30.
Make checks payable to Brandeis National Committee [BNC]
REMEMBER: Dues are TAX DEDUCTIBLE
Or Charge my BNC membership dues of $_________________ to
___Visa ___MasterCard ___AmEx
Account number_______________________________________
Security No: ___________ Expiration date: __________
Signature: ________________________________________
For mailing information, contact:
Naomi Javitz 3541 Green Vista Dr. Encino, CA 91436 818-783-5419 naomijavitz@brandeissfv.org |
THANK YOU
for becoming a member of the Brandeis National Committee (BNC)
and for your contributions
Brandeis National Committee - San Fernando Valley Chapter
©2022 San Fernando Valley Chapter, Brandeis National Committee. All rights reserved.