Membership Form

It is easy to become a member! Just fill in the form, print this page out on your printer, and then mail it to the address below.

I would like to become a member and help support the work of the foundation. Please mail me the audio cassette, "The Day All Radio Went Silent".

Name
Company
Address
City, State
Postal Code
Country
Telephone
Fax
E-mail address
Membership level	Student - $15.  Supporting-$100.  Charter - $25.  Silver- $250.  Associate - $25.  Gold $1000.  Sustaining - $50.  Platinum $2500.   Other
Payment Method	Check Please make your check payable to: Guglielmo Marconi Foundation, USA, Inc. Diner's Club  Visa MasterCard Discover  American Express Diner's Club  Card number  Expiration date
Total	Date
Signature
Comments please
Other Contributions	Please contact me- I have some radio equipment which I would like to donate. Please contact me - I may be able to volunteer at the museum.