Membership Form
Name 1:____________________________________________
Name 2:____________________________________________
(Family Memberships may be in two names at the same address)
Address____________________________________________
City/State/Zip________________________________________
Daytime phone_______________________________________
UC Student ID#_____________________________________
My check for __________ is enclosed.
(Make check payable to the Oriental Institute)
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
Fax: (773) 702-9853