Your membership is
The membership is available at the following levels:
Please mark one.
[ ] Student/Senior $15.00
[ ] Member (Family) $20.00
[ ] Supporting Member $50.00
[ ] Sponsor $100.00
[ ] Patron $200.00
[ ] Jack London Fellow $500.00
[ ] Life Time Member $1000.00
Phone _____-_____-_______ E-mail _____________________
Payments may be made by check, U.S. Postal money order, international money order, American Express, MasterCard, or Visa. Please make checks or money orders payable to Jack London Foundation, Inc. There will be a $2.00 Service Charge for use of Credit Cards.
[ ] American Express [ ] MasterCard [ ] Visa
Number____________________ Exp. Date___________ CVS ________
Name on Card________________________
Mail application to: