The Capitol Dome

Fall 2014

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THE CAPITOL DOME 55 Complete form and fax to: (202) 544-8244,or call toll-free at (800) 887-9318. Item Number Quantity Unit Price Extended Price READER RESPONSES 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 MEMBERSHIP: e 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. _______________________________ _______________________________ _______________________________ EVENT REGISTRATION: List the events that you wish to attend. Include your name(s) and a phone number and email ad- dress at which we may contact you. YES, I/WE WILL ATTEND: _______________________________ _______________________________ _______________________________ You may fax this form to (202) 544-8244 or mail to: USCHS, 200 Maryland Ave., NE Washington, DC 20002-5796 Questions? Call toll-free: (800) 887-9318 ext. 10 For local calls: (202) 543-8919 ext. 10 YOUR INFORMATION LEVEL OF MEMBERSHIP METHOD OF PAYMENT 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):_____________________________________ 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. FOR PACKAGES OVER 25 LBS., ADD $10.00 PER 10 LBS. SUB-TOTAL: *TA X:_____________________ SHIPPING: MEMBERSHIP: TOTAL DUE: DOME MARKETPLACE Name(s):________________________________Phone:__________________ Street Address:___________________________________________________ City:______________________State:_________Zip Code:_______________ Email:_________________________________________________________ CHECK ALL THAT APPLY: New Membership Membership Renewal Gift Membership Event Registration Marketplace Order Volunteering $50-$74 $75-$99 $100-$249 Charter Member Freedom Society Cornerstone Society $250-$499 $500-$999 $1,000-$2,499 Rotunda Society Architect of History Capitol Circle Please record me as a Capitol Alumni Member* *MD Tax (6.0%) & DOC Tax (5.75%)

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