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Complete the appropriate sections of this page to enroll as a Society member, renew your membership, give a gift membership, or order items from e Dome Marketplace. If you are giving a gift membership, please provide the person's name and address below. GIFT MEMBERSHIP: _____________________ _____________________ _____________________ CAPITOL ALUMNI MEMBERS Tell us your connection with the Capitol. _____________________ _____________________ EVENT REGISTRATION: List the events that you wish to attend. Include your name (s) and contact in- formation. YES, I/WE WILL ATTEND: _____________________ _____________________ You may fax this form to: (202) 544-8244 or mail it to: USCHS, 200 Maryland Ave., NE Washington, DC 20002-5796 QUESTIONS? Toll-free (800) 887-9318 x10 Local calls: (202) 543-8919 x10 Item Number Quantity Unit Price Extended Price Complete form and fax to (202) 544-8244, or call toll free: 1-800-887-9318, ext. 10 SHIPPING AND HANDLING $20.00 (OR LESS) $7.95 $50.01 to $75.00 $18.95 $20.01 to $30.00 $9.95 $75.01 to $100.00 $24.95 $30.01 to $40.00 $12.95 More than $100.00 $34.95 $40.01 to $50.00 $14.95 Please add $25.00 shipping for each framed print ordered. For packages over 25 lbs., add $10.00 per additional 10 lbs. SUB-TOTAL: _______________________ TAX (6% DC & MD): ________________ SHIPPING: _________________________ MEMBERSHIP: _____________________ TOTAL: ____________________________ Enclosed is a Check or Money Order payable to: U. S. Capitol Historical Society I am paying by Credit Card (please circle one): VISA MC AMEX DISCOVER CARD # ______________________________ EXP. DATE: ______________ CODE: _____________ Cardholder Signature (required): _________________________________________________________ USCHS Board of Trustees Hon. Kenneth E. Bentsen, Jr. Hon. Roy Blunt Ken Bowling, Ph.D. Nicholas E. Calio Sean Callinicos Donald G. Carlson Hon. E. omas Coleman L. Neale Cosby Scott Cosby George C. "Bud" Garikes Mary Moore Hamrick Hon. Richard Holwill Tim Keating Hon. Dirk Kempthorne Hon. John B. Larson Jennifer LaTourette Rob Lively Brett Loper Tamera Luzzatto Norm Ornstein, Ph.D. Craig Purser David Regan Cokie Roberts Hon. Ron Sarasin Matthew Shay Mark Shields William G. Sutton, CAE Hon. Ellen O'Kane Tauscher James A. urber, Ph.D. Connie Tipton Hon. John C. Tuck Hon. Tom Udall Mark Valents III J. Dennis Molloy (counsel) e Capitol Dome is a quarterly publication of the U.S. Capitol Historical Society, 200 Maryland Ave., NE, Washington, DC 20002 P: (202) 543-8919 F: (202) 544-8244 Toll Free: 1-800-887-9318 Email: uschs@uschs.org Web: www.uschs.org Cheif Historian: Donald R. Kennon Editor: Lauren Borchard Designer: Diana E. Wailes All uncredited photos are courtesy of the U. S. Capitol Historical Society. For more information on membership categories and benefits, visit: www.uschs.org. For additional product choices, visit: www.uschscatalog.org or www.constitutionstore.org. READER RESPONSES Y O U R I N F O R M A T I O N Name(s)______________________________ Email: _________________________ Street Address: _______________________________Phone:___________________ City: _________________________ State: ___________ Zip Code: _____________ CHECK ALL THAT APPY: New Membership Membership Renewal Gift Membership Event Registration Marketplace Order Volunteering L E V E L O F M E M B E R S H I P $50-$74 $75-$99 $100-$249 Charter Membership Freedom Society Cornerstone Society $250-$499 $500-$999 $1,000-$4,999 Rotunda Society Architect of History Capitol Circle Please record me as a Capitol Alumni Member D O M E M A R K E T P L A C E M E T H O D O F P A Y M E N T 10