Brattle Membership Enrollment Form

If you'd like to purchase this membership as a gift, please click here.

Membership Level*
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I would also like to contribute to cover the credit card fee charges (approx 3%)
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Billing and Contact Information
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First Name*
Last Name*
Address*
City*
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Zip*
Phone*
Email*
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Preferred Mailing Address for the Membership
If your preferred mailing address is different from above, please enter that here
Payment Info
Member Information
Name on Member Card (2 names needed for Dual/Producer Members)*
Secondary Member's Email (for Dual/Producer Members)