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Sigerist Circle

2010 Membership/Renewal Form

To join or renew your membership in the Sigerist Circle, please fill in this form and return it to the address indicated below.

Annual membership dues are $15 regular members and $5 for students and low income persons.

Enclosed is a check for $______USD, of which $_____ is my 2010 dues and $_____ is a contribution.

Make checks payable to the Sigerist Circle, in USD only, please. 

_________________________________________________________________

Join: ____  Renew: ____

Name:

Email:

Address:

City:

State/Province:

Zip/Postal Code:

Phone:

_________________________________________________________________

Mail completed form and check (USD only, please) to:

Sigerist Circle

c/o Corinne Sutter-Brown

63 Nicholson Street

Rochester, NY 14620

USA

Did you forget to renew in 2009?

Do it now!