To become a Scriabin Society of America member:
1.
Complete the form below.
2.
Print this page once all information has been entered.
3.
Mail the completed form application and appropriate payment to:
Edith Finton Rieber, President
The Scriabin Society of America
353 Lindsey Drive
Berwyn, PA 19312
 YOUR INFORMATION (required)
Name:
Address:
City:
State/Province:
Zip/Postal Code:
Phone:
Fax:
E-mail:

 SELECT MEMBERSHIP TYPE (required)
Regular ($40.00)
Supporter ($300.00)
Student ($25.00)
Benefactor ($500.00)
Institution ($75.00)
Patron ($1,000.00 +)
Donor ($100.00)

 ADDITIONAL ITEMS (optional)
Exclusive Archival Edition ($40.00 members), ($60.00 non-members) + $5.00 Postage -- Compiled and annotated by Donald M. Garvelman; Foreward by Faubion Bowers
Faubion Bowers' biography of Scriabin ($25.00 members), ($30.00 non-members)
Discography ($12.00 members), ($15.00 non-members)
Bibliography ($5.00 members), ($15.00 non-members)
SAVE!! -- Discography and Bibliography together ($12.00)
CD Scriabin As Pianist, his recordings ($15.00 members only)
Contribution to the Faubion Bowers Memorial Fund ($__________)

 COMMENTS (optional)

PRINT THIS COMPLETED FORM AND MAIL IT IN WITH YOUR PAYMENT.