Submission of this form and a contribution of $400.00 per person constitutes acceptance of my reservation. I understand that I am responsible for payment in full 45 days prior to departure.

Last Name___________________________________First______________________

Passport No.________________________________Exp. Date__________________

Last Name___________________________________First______________________

Passport No.________________________________Exp. Date__________________

Address___________________________________________________________

	__________________________________________________________

City/State/Zip____________________________________________________

Daytime phone_____________________________________________________

Evening phone_____________________________________________________


I enclose a tax-deductible contribution of $400.

___My check made payable to the Oriental Institute is enclosed.

___Please bill my __MC	__Visa

Account number____________________________________________________

Expiration date___________________________________________________

Signature_________________________________________________________


Please return this form with payment to:

The Oriental Institute Membership Office,
1155 East 58th Street, 
Chicago, Illinois, 60637  
USA
Phone 773-702-9513
Fax  773-702-9853