Membership Data Form

Please provide the following information to be included in the Guild's Directory/Database:

New Member 2011/12?		Yes No
If renewing:		Member Since
Your Name (and title):
Email Address:
Mailing Address:		Street: City: State: Zip+4:
Home Phone:
Cell Phone:
Work Phone:
Fax:
About me/ Occupation:
My Birthday:		Month: Day:
Spouse's Name (include preferred title):

If spouse is joining as a Dual Member, please provide the following:		Email: Cell Phone: Work: Fax: Birth Month: Birth Day:

Members have a choice to receive a printed copy of the directory. Some members prefer printing their own copy or using the online directory available to members at our website: www.balletaustinguild.org Please indicate your directory preference: I am a first-time member of the Guild and would like to receive my FREE membership directory Binder plus insert pages $7 Directory Insert Pages (no binder) $3 No directory requested

Membership Categories and Annual Dues - Please select only ONE category

Active Membership		Active 35 and Under $75 Active Individual $155 Active Dual (includes spouse) 35 and Under $150 Active Dual (includes spouse) $230
Supporting Membership (available after 2 years' membership)		Supporting Individual $200 Supporting Dual (includes spouse) $275
Lifetime Member (only available to current Life Members)		Active Life Member $30 Active Dual Life (includes spouse) $75 Inactive Life Member (no charge)

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