2011 Application for Membership
in the American Wine Society

Complete and Mail to: OR Fax to: 937-529-7888
American Wine Society
_____________________________________________________________
Last Name
First
Name
______________________________________________________________________________
Spouse/Significant Other
First Name
______________________________________________________________________________
Business Name (If
Applicable)
______________________________________________________________________________
Address
______________________________________________________________________________
City
State
Zip Code
______________________________________________________________________________
Phone w/Area Code
E-Mail (Please print clearly)
______________________________________________________________________________
AWS Chapter Affiliation (if
known)
Birth date
How would you like to
receive the AWS Wine Journal
magazine: By e-mail:________
Paper copy in the mail ______
______
Renewal
______
New Membership
Check type of membership
_____ Individual Membership
$49
_____ Household Membership
(Jan-Dec) – two people at same address
$62
_____ Half-year Membership
after July 1 - for new members only
$35
_____ Professional
Membership (includes
wall plaque)
$85
_____ Lifetime
$950
_____ Student Membership
(21 - 25 years old with student ID)
$25
_____
Method of Payment:
_____Check ______Visa ______MC_______Am
Express _____Discover
Name as shown on card:
____________________________________________________________
_______________________________________________________
Security code:
_______
Credit Card Number
________________________________________________________________________________
Expiration Date
Cardholder’s Signature