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
Yes! I'd like to join the Renwen Society

checkbox one year checkbox two years checkbox three years

checkbox Individual Membership $55 ($40 tax deductible)
checkbox Student and Senior $40 ($25 tax deductible)	

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

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: