desertfilmsociety - 2006 Membership Application Form
 

NOTE:  PLEASE PRINT VERY CAREFULLY...

NAME:_______________________________________________________________________________

Street/Mailing Address:
_____________________________________________________________________________________

City:  _________________________________________ State:  ______  Zip:  _____________________

E-mail Address: _______________________________________________________________________

Telephone #: ________________________________  Fax #: ___________________________________
 

I hereby give consent to the desertfilmsociety to publish my name, only, in their WebSite

_________________________________________________________________
Signature

DATE:  ___________________________________________

NOTE:  Indicate with an "X" in the box how you'd like to receive your Membership Card:
Hold my Membership Card for Personal Pickup at a DFS Screening
Mail the Card to me.  I understand that lost membership cards are not replaced.

Attach a check or money order in the sum of $98.00, made payable to
DESERT FILM SOCIETY
and mail it with this application form to:

Desert Film Society
PO Box 8147
Palm Springs, CA  92263-8147


For Office Use Only:  $98.00 Received & Membership Card issued,
by: ____________________  on:  ______________________

RECEIPT
desertfilmsociety acknowledges receipt of $98.00 from:

__________________________________________________________________________________________
for DFS Membership for 2006  (Expires on December 31, 2006)
Date:  _______________       ________________________________________________________________

desertfilmsociety 
PO Box 8147, Palm Springs, CA  92263-8147