DSSV Membership Application

Deutscher Sprach-und Schulverein - German Language and School Society

   Name________________________________________________

   Address______________________________________________    

   City______________________ State________ Zip___________

   Telephone ( ______ ) _______ -_______________

   email _____________________________________

   Membership Type:

     □ Family  $15.00  □ Individual  $10.00 

     □ Student  $3.00    □ Senior (Over 65)  $5.00

    
  Membership Dues      __________

   Additional Donation   __________

   TOTAL Enclosed    $ __________ Dues and donations are tax deductible.

   Please print this Membership Application, provide the requested
   information and mail this form along with your contribution check to:

     DSSV
     15205 Fieldstone Drive
     Brookfield, WI 53005