Membership Form

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Print this form and mail or fax it with payment to: China Institute, 125 East 65th Street, New York, NY 10021-7088 USA, Fax: 1-212-628-4159

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Yes! I'd like to join China Institute

checkbox one year 
checkbox two years (Plus 1 extra month)
checkbox three years (Plus 3 extra months)
General Membership checkbox Individual Membership $55 ($40 tax deductible) checkbox Dual/Family Membership $95 ($65 tax deductible) Special Memberships Friends of the Gallery checkbox Friend (Pengyou) from $1,500 ($1,300 tax deductible) checkbox Sponsor from $2,500 ($2,300 tax deductible) checkbox Leader from $5,000 ($4,725 tax deductible) checkbox Patron from $10,000 ($9,725 tax deductible) checkbox Benefactor from $25,000 checkbox Young Associates $100 ($40 tax deductible) checkbox China Institute Women's Association $55 ($40 tax deductible) checkbox Renwen Society $55 ($40 tax deductible) Supporting Memberships checkbox Red Envelope $250 ($200 tax deductible)
checkbox Silk Purse $500 ($440 tax deductible) checkbox Jade Box $1000 ($900 tax deductible) checkbox Scholar’s Circle $2,500 ($2,300 tax deductible) Corporate Membership checkbox Corporate Sponsor $2,500 checkbox Corporate Leader $5,000 checkbox Corporate Patron $10,000 checkbox Corporate Benefactor $25,000 checkbox Mr. checkbox Mrs. checkbox Ms. checkbox Miss checkbox Mr. and Mrs. Name ____________________________________________________________ Street __________________________________________________Apt.____ City _____________________________________ State ___ Zip ________ Phone(home) _____________________ (work) ________________________ Fax _____________________________ Email _________________________ I have enclosed my check, payable to: China Institute in America Or charge my checkbox Visa checkbox MC checkbox AmEx checkbox Discover Number _________________________________ Exp. Date _______________ checkbox My employer has a matching gift program that will increase my support to China Institute. I have enclosed my company's form. checkbox This is a gift membership. The name on the membership card should read: ___________________________________________________________________
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