Brewster Society Order Form

Name:__________________________________________________________________

Address:________________________________________________________________

City/State/Zip:_________________________________________________________

Country:________________________ Daytime Phone:________________________ 

Email: _________________________

________ YES! I want to BELONG to the Brewster Society!
                                                           
Annual Membership Dues ($45 / year)  __________

OR

International Annual Membership Dues ($50 / year)  __________
                                                           
TOTAL AMOUNT ENCLOSED (Check or Money Order) __________

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