Membership Form
Please print out and send to the address below:
Membership Categories (check one)
Regular Member
________Individual $25.00
________Joint $40.00
________Life Member $500.00 (payable in four installments)
Student Member
______Undergraduate Student $15.00
______Graduate Student $15.00 (which degree?) ___________
School:_____________________ Expected Graduation Date _______
Name:____________________________________________________
Address: __________________________________________________
_______________________________________________Zip________
Organizational Affiliation: ____________________________________
Email address: ____________________________________________
How did you learn about The Langston Hughes Society? __________
_________________________________________________________
Please remit your dues by check MADE PAYABLE TO “The Langston Hughes
Society” and send check along with this form to:
Sharynn Owens Etheridge
Treasurer, Langston Hughes Society
690 Wilson Street
Orangeburg, SC 29115
