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Waxahachie Chautauqua 2012
Membership Form

Join or renew by August 15, 2012 
to receive
two complimentary tickets to Chautauqua 2012
Name(s):
_________________________________________________
Address: _________________________________________________
City: ________________________  State:_____  ZIP:___________
Phone: ________________________
Email:
 _________________________________________________

__ Check here to receive occasional Chautauqua Notes email updates.
I am a (check one):    ___New Member     ___Renewing Member

Membership Levels & Associated Benefits:
(PLEASE CHECK ONE)
__ Basic $25
 Mailings, Notices & Assembly Updates for 2012
Two Complimentary Tickets to Assembly (Saturday, September 22, 2012)
__ Supporter $60
 All of the above, plus…
Name Listed in Assembly Day Printed Program 
__ Founder* $120
 All of the above, plus…
Invitation for two to Chautauqua 2012 "Cotillion Ball"
__ Sponsor* $250
 All of the above, plus...
A special gift from Waxahachie Chautauqua
__ Lifetime Patron* $600
(one time payment)
 All of the above, plus…
 Patron Benefits for Life
Name/Email/Link on Chautauqua’s website


Just print this page
and send it along with your check to:

Chautauqua Preservation Society
PO Box 126
Waxahachie, Texas 75168