corporate membership application

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

____________________________________________ Company Name

____________________________________________ Contact Name/Title

____________________________________________ Address

____________________________________________ City/State/Zip

Telephone_______________________ Fax_____________________ Email________________________

Membership Category:

O	Blue Ribbon		US$3000			O	Donor		US$1500
O	Corporate Associate		US$ 500			O	Corporate		US$ 1000
O	Institutional		US$ 350

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

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.