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Please print this form and mail to AFD Membership Secretary 22 Academy Street Arlington Ma 02476

First Name ___________________ Last Name____________________

Address______________________ Town______________State Zip_________

Home Phone___________________ E-Mail___________________

(okay to publish in directory?) YES ( ) NO ( )

(____)	Membership(s) @ $65 each	$______
(____)	Student Membership(s) @ $32.50 each	$______
(____)	Enclosed is my tax-deductible gift to AFD	$______
	Total	$______

Payment may be made by check payable to Arlington Friends of the Drama Print and mail this form with your check a information to AFD Membership Secretary 22 Academy Street Arlington Ma 02476