Civil War Round Table of DC
Membership Application and Annual Dues for 2012-2013

Annual Dues are $30.00 ($15.00 after January 31, 2013). The dues must be
received by October 1, 2012, for members to continue receiving the newsletter.
Please make your check payable to CWRT of DC.

[ ] New Member  [ ] Renewal  [ ] Address Change     Date Submitted: ______________

Name: _________________________________________________________________________

Address: ______________________________________________________________________

Address: ______________________________________________________________________

City: _________________________________________________________________________

State: ____________________________  Zip (plus 4): __ __ __ __ __ - __ __ __ __ 

Email: ________________________________________________________________________

Home Phone: (______) ______ - ________ Office Phone: (______) ______ - ________

[ ] Check here to receive the newsletter by email (default distribution method).
   This choice saves $10 per member that can be used the help pay for speakers
   and for Civil War preservation projects.

[ ] Check here to receive the newsletter by USPS mail.
   An additional contribution will help to defray the cost of this option.

The above information is for the membership files and will be published in the
membership roster.

Please mail this form and your dues to:

	CWRT of DC Membership Committee
	Kenneth R. Rice
	4110 N. 17th Street
	Arlington, VA 22207-3005

If you have any speaker or topic preferences for future meetings, please provide them below.