Please return this form with your 2012 MDSD membership dues
of $20.00. We would appreciate it if you would notify
Treasurer Rich Masartis (
rmasartis@aol.com )of any changes in regular or email address during the year.
Please
print clearly
First Name(s)________________________________________ I would like to receive the Noter:
Last Name__________________________________________ ( ) By email
Address____________________________________________ ( ) Printed copy at club or by US mail
City__________________________ State ____ Zip________ ( ) Both ways
Phone (_____)____________________________
Email____________________________________
Amount enclosed: $___________
Has any of this information changed since last year? Yes ( ) No ( )
Are you a new member? Yes ( ) No ( )
Make check payable to the Mountain Dulcimer
Society of Dayton.
Send check and this registration form to:
Rich Masartis, 1801 Westchester Court, Springboro, OH 45066