Application Brandeis Men's Group, L.A.; Brandeis National Committee

Name: _______________________________________________

Address: _____________________________________________

Telephone: ___________________________________________

Cellphone: ____________________________________________

E-mail address:_________________________________________

Annual dues are $50 per year for Brandeis Men's Group (BMG), L. A. membership.

You will be billed an additional $60 for annual Brandeis National Committee (BNC) dues. All dues are tax deductible.

To join, please fill out the form above and mail your $50 check made out to BMG, and a separate check made out to BNC to:

Bernard Schneier
311 Bora Bora Way Apt 204
Marina del Rey, CA 90292-8305