Al Jolson Society

The International
Al Jolson Society

MEMBERSHIP RENEWAL FORM

This form is for renewal of existing membership of the International Al Jolson Society. New member applications should use the new member application form. Current dues is US$25 (UK£16). Send your dues, drawn on a US bank, to the treasurer at:

US and non-UK	UK
Sandra K. Gerloff 419 Glenwood Drive Douglassville, PA 19518 USA	David McCarthy 87 Brocket Way Chigwell Essex IG7 4EU

or you can pay by credit card via PayPal. Payment submitted over the web will have a $1 processing surcharge added. Please be sure to fill out all blanks, including your Email address, so that I can acknowledge your submission!

* Required fields
            Name: *
  Street address: *
                  
            City: *
  State/Province: *
        Country*:  *if not US
 Postal/ZIP Code: *
       Telephone: ( )  ext: North America only
                  ++-  ext: outside North America
   email address: *
      occupation: 
       birthdate: 
Any comments? Any news or questions?

Please indicate payment method
Check or Money Order via Snailmail . . . . . . PayPal via web [PayPal link for payment on the next page]

Thank you for your information, please press the RENEW button
to send the information to the International Al Jolson Society.

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