2011 Application for Membership in the American Wine Society

 

                        Complete and Mail to:                   OR              Fax to: 937-529-7888

                        American Wine Society                      

                        PO Box 279                                     Questions?  Call 888-297-9070

                        Englewood, OH 45322

                                                                                               

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Last Name                                                                              First Name                                                         

 

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Spouse/Significant Other                                                       First Name                                                       

 

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Business Name (If Applicable)

 

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Address

 

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City                                                          State                                                     Zip Code

 

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Phone w/Area Code                                       E-Mail (Please print clearly)

 

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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

_____ Canada and all other countries outside the US, add $5 to above amounts

 

Method of Payment:   _____Check  ______Visa ______MC_______Am Express _____Discover

 

 

Name as shown on card: ____________________________________________________________

 

 

_______________________________________________________ Security code: _______

Credit Card Number

 

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Expiration Date                                               Cardholder’s Signature