Membership Form

Our Membership/Subscription-year begins January 1. All memberships are for a calendar year from January 1 to December 31. We strongly encourage members to renew during the Fall months for the upcoming year. Please send your dues to

Poets and Patrons Treasurer
Beth Staas
10 Oak Ave. #107
Westmont, IL 60559
beth@staas.com

Membership Year
_____ 2011
_____ 2012

Membership Status
_____ New
_____ Renewing

Regular Membership
_____ $15 United States

Contest Sponsorship
_____ $50 Sponsor

We are especially grateful to those who choose membership in special categories; It is difficult to meet our publication and mailing expenses on income from standard memberships only.

Payment method

_____ Check
_____ Money Order
______________________________________
Name

Please make checks payable to Poets and Patrons.

______________________________________
Address