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and complete this form. Send with your payment to: Poets House 594 Broadway, Suite 510 New York, New York 10012 |
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| Name: | |
| Address: | |
| City: | |
| State: | |
| Zip Code: | |
| Country: | |
| Phone: | |
| Email: | |
| I wish to join Poets House at the following level: | |
| __ | Member ($40) |
| __ | Associate Member ($75) |
| __ | Patron ($100) |
| __ | Sponsor ($250) |
| __ | Funder ($500) |
| __ | Benefactor ($1,000) |
| __ | Check here to forgo membership benefits, making your gift entirely tax-deductible. |
| __ | Check here if this a matching gift. |