YES! I want to become a member of
The Japan Society of Boston

Please join us by printing this form out, completing it, and mailing or faxing it back to:
The Japan Society of Boston, Inc.
One Milk Street
Boston, MA 02109
FAX 617-451-1191

____________________________________________ Name

____________________________________________ Address

____________________________________________ City/State/Zip

______________________ Daytime Telephone ______________________ Evening Telephone ______________________ Daytime or Evening Fax# ______________________ Email

Membership Category:

O	Friend		US$700			O	Sustaining		US$300
O	Contributing		US$150			O	Family		US$ 60
O	Overseas		US$ 45			O	Senior		US$ 30
O	Individual		US$ 45			O	Student		US$ 20

I would like to make an additonal contribution to the Japan Society of Boston:	US$____
Membership Dues:	US$____
TOTAL:	US$____

O	Check Enclosed (please make payable to the Japan Society of Boston)
O	Please Charge My:  O Visa   O MasterCard ____________________________ _________ Account # Expiration ____________________________   Signature

How/ where did you hear about the Japan Society of Boston?
O Advertising O Business Forum O Direct mail O Friend O Program O Web O Other
Please indicate if you would like to receive materials about the following:
O Japanese Language Program
O Book Order Form
O Corporate/Institutional Membership
Interested in Volunteer Opportunities?
There are many interesting opportunities to get involved with the Society and meet fellow members by volunteering.
I would like to Volunteer, helping with:
O Programs O In-office tasks O Special Events O Mailings
The best time to contact me:
O Morning O Afternoon O Leave message, and I will return your call.

Thank you for your interest. We look forward to welcoming you as a member of the Japan Society of Boston. If you have any questions please do not hesitate to call us at 617-451-0726.