George Moses Horton Society Membership form

The George Moses Horton Society for the Study of African American Poetry Membership Form

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Name Last First Middle

Home Address________________________________________________

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City State ZIP

Home Telephone Number_________________________

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Institutional Affiliation
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Departmental Address
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City State ZIP

Telephone Number________________________

Email address_____________________________

Preferred Mailing Address: Home________ School ______

Current Poetry Projects ________________________________________
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TWO-YEAR MEMBERSHIP DUES:

Institutional $100.00___________ Faculty $50.00______________

Graduate Student $25.00_____________ Other $25.00_________ Life $500 __________

Please make check or money order payable to The George Moses Horton Society and return to:

Ms. Fiona Mills Secretary-Treasurer The George Moses Horton Society English/UNC, Chapel Hill CB# 3520 Greenlaw Hall Chapel Hill, NC 27599-3520 email: horton@unc.edu

Return to the George Moses Horton Society homepage
Last update 2/1/01