The Capitol Dome

Summer 2013

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YOUR INFORMATION Name(s): READER RESPONSES E-mail: Street Address: City: State: Zip Code: CHECK ALL THAT APPLY: q New Membership q Event Registration q Membership Renewal q Marketplace Order q Gift Membership q Volunteering LEVEL OF MEMBERSHIP q $50-$74 q $75-$99 q $100-$249 Charter Member Freedom Society Cornerstone Society q $250-$499 q $500-$999 q $1,000-$4,999 Rotunda Society Architect of History Capitol Circle q Please record me as a Capitol Alumni Member* Complete form and fax to (202) 544-8244. Or call toll-free at (800) 887-9318. DOME MARKETPLACE Item Number Quantity Unit Price Complete the appropriate sections of this page to enroll as a Society member, renew your membership, give a gift membership, or order items from The Dome Market Place. If you are giving a gift membership, please provide the person's name and address below. GIFT MEMBERSHIP: *CAPITOL ALUMNI MEMBERSHIP: The Society recognizes the service of individuals, family members and descendants of those who have served in the U. S. Congress. Our Capitol Alumni members represent the living history that USCHS is charged to preserve. To become a Capitol Alumni Member, please tell us your connection with the Capitol. Extended Price EVENT REGISTRATION: List the events that you wish to attend. Include your name(s) and a phone number at which we may contact you. SHIPPING AND HANDLING $50 to $75 $18.95 less $7.95 $7501 to $10000 $24.95 $3000 $8.95 MORE THAN $100.00 $34.95 $4000 $12.95 $5000 $14.95 PLEASE ADD $2500 SHIPPING FOR EACH FRAMED PRINT. FOR PACKAGES OVER 25 LBS., ADD $10 PER ADDITIONAL 10 LBS. $20 or $2001 to $3001 to $4001 to 00 01 00 SUB-TOTAL: MEMBERSHIP: TOTAL DUE: METHOD OF PAYMENT q Enclosed is a Check or Money Order payable to: U.S.Capitol Historical Society q I am paying by Credit Card (please circle one): VISA MC AMEX DISCOVER CARD # Cardholder Signature (required): YES, I/WE WILL ATTEND: SHIPPING: Expiration Date: You may fax this form to (202) 544-8244 or mail it to: USCHS, 200 Maryland Ave., NE Washington, DC 20002-5796 Questions? Call toll-free (800) 887-9318 For local calls, (202) 543-8919, ext. 10.

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