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Associates of the Cushing/Whitney Medical Library: Membership Form

To become (or remain) a member of the Associates of the Cushing/Whitney Medical Library, please print out and mail this form with your contribution to:

Associates of the Cushing/Whitney Medical Library
333 Cedar Street
P.O. Box 208014
New Haven, CT 06520-8014

Member:	$35.00 yearly
Contributing Member:	$100.00 yearly
Sustaining Member:	$250.00 yearly
Life Member:	$1000.00 one time fee

Name:	______________________________________________
Street Address:	______________________________________________
City, State:	______________________________________________
Zip Code:	______________________________________________

Payment Options

You may make payment by check (make checks payable to Associates of the Cushing/Whitney Medical Library) or by Mastercard/Visa (please complete the following information:

Card #:	______________________________________________
Expiration date:	______________________________________________
Name on card:	______________________________________________
Signature:	______________________________________________

Thank you for your support of the Cushing/Whitney Medical Library!

Site URL: http://www.med.yale.edu/library/