Please PRINT this form, complete, and mail with your check as indicated below. Thanks for your interest in MHKS!

Membership Application Form

Regular Membership $45 _________

Student Membership $25 _________

Gift Membership* $45 _________

Life Membership $500 _________

Joint Membership with Southeastern Historical Keyboard Society $10 _________

Additional Donation _________

Total _________

Name __________________________________________

Address_________________________________________

City _____________________________ State _________ Zip Code ____________

Country _________________ Telephone: ______________________________(home)

______________________________(work)

_______________________________(fax)

E-mail ___________________________________

Comments:_____________________________________________________________

______________________________________________________________________

Make checks payable to MHKS and send to David C. Kelzenberg, MHKS Secretary, 2801 Highway 6 East, #344, Iowa City, Iowa 52240, USA.

Membership renewals are due on July 1, of each year. Delivery of the fall issues of MHKS publications such as The MHKS Newsletter, News of Members, and The Early Keyboard Journal cannot be guaranteed for renewals received after October 15.

*For gift memberships, please provide the name and address of the person to whom you would like to give a membership in MHKS.