Please print out and complete this form and mail it to the Society.

Membership and Subscription Form

THE DEAN BURGON NEWS
Published As the Lord Supplies By The Dean Burgon Society,  D. A. Waite, Editor,
Box 354 - Collingswood, NJ 08108

Editorial Committee:  M.J.Hollowood &  D. A. Waite

SEND GIFT SUBSCRIPTIONS: All gifts to Dean Burgon Society are tax deductible!
THE DEAN BURGON SOCIETY
Box 354 - Collingswood, New Jersey 08108, U.S.A.
Phone: (856) 854-4452

MEMBERSHIP FORM

I have a copy of the "Articles of  Faith, Operation, and Organization" of The Dean Burgon Society, Incorporated. After reading these "Articles," I wish to state, by my signature below, that I believe in and accept such "Articles." I understand that my "Membership" is for one year and that I must renew my "Membership" at that time in order to remain a "Member" in good standing of the Society.

[  ] I wish to become a member of The Dean Burgon Society for the first time.
[  ] I wish to renew my membership subscription which has expired as of: ___________
SIGNED:____________________________
DATE:______________________________

I enclose: (Attention: The Dean Burgon Society Box 354 - Collingswood, New Jersey 08108)
*Membership Donation ($15.00/year)     $__________
*Life Membership Donation ($100.00)    $__________
*Student Membership Donation ($7.00/year) $__________
*Additional Donation To The Society   $__________

TOTAL:                                                 $__________

Please PRINT in CAPITAL LETTERS your name and address below:
NAME:__________________________________________
ADDRESS:______________________________________
CITY:___________________________________________
STATE:________________________ ZIP:_____________
E-mail Address:__________________________________
Phone Number:__________________________________

[  ] Although I am not a member of The Dean Burgon Society, I do wish to subscribe to the Newsletter, by making a gift of $10.00 to the Society.
NAME:__________________________________________
ADDRESS:______________________________________
CITY:___________________________________________ 
STATE:________________________ ZIP:_____________

E-mail Address:__________________________________
Phone Number:__________________________________

I understand that, included in my first $10.00 gift accompanying any donation or order regardless of the amount of the order or donation is my year's subscription to The Dean Burgon Society NEWS-LETTER. ( Canada & All Foreign Subscriptions $12.00 Yearly)