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Complete the appropriate sections of this page to enroll as a Society mem- ber, renew your membership, give a gift membership, or order items from e Dome Marketplace. If you are giv- ing 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 REGISTR ATION: List the events that you wish to attend. Include your name (s) and contact information. 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 $8.95 $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. Richard Baker, Ph.D. Hon. Kenneth E. Bentsen, Jr. Ken Bowling, Ph.D. Hon. Richard Burr Nicholas E. Calio Donald G. Carlson Hon. E. Thomas Coleman L. Neale Cosby Scott Cosby Nancy Dorn George C. "Bud" Garikes Bruce Heiman Hon. Richard Holwill Tim Keating Hon. Dirk Kempthorne Hon. John B. Larson Jennifer LaTourette Rob Lively Tamera Luzzatto Tim Lynch Norm Ornstein, Ph.D. Beverly L. Perry David Regan Cokie Roberts Hon. Ron Sarasin Mark Shields Dontai Smalls William G. Sutton, CAE Tina Tate Hon. Ellen O'Kane Tauscher James A. Thurber, Ph.D. Hon. Pat Tiberi Connie Tipton Hon. John C. Tuck Hon. Tom Udall 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 Chief Historian: Donald R. Kennon Editor: Lauren Borchard Designer: Diana E. Wailes All uncredited event 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 APPLY: 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 13