2010-2011 Subscription Form

Please complete the form below and return it with your payment and a stamped, self-addressed envelope to:

Chamber Music in Yellow Springs (CMYS)
Box 448,
Yellow Springs, Ohio 45387.

Please print or type. If we need to make changes on your
mailing label, please mark corrections on the reverse of this form.

Please send ______ subscriptions (5 concerts) @ $75

Please send ______ subscriptions (5 concerts) @ $25
(elementary, secondary, and full-time college students with ID)

My check is in the amount of $______; it includes a tax-deductible
contribution of $______.

Name ______________________________________________

Street Address _______________________________________

City ______________________ State ___ ZIP _________

Telephone ___________________________________________

E-mail ______________________________________________

Thank you!

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