International Lawrence Durrell Society

Membership Form

NOTE: This is not an on-line form. Please print the page, fill it out, and mail it to the address at the bottom of the form.

The International Lawrence Durrell Society

Membership in the Society entitles you to receive The International Lawrence Durrell Society Herald, the Society's membership directory, and advance information about the biennial Lawrence Durrell conferences and activities. Your membership dues help fund these conferences as well as other Society activities and publications.

Name: ___________________________________________________________________________________

Home Address: ____________________________________________________________________________


Home Telephone: __________________________________________________________________________

Office Address: ___________________________________________________________________________


Office Phone: ___________________________________


E-Mail: __________________________________________________________________________________

Where do you prefer to receive mail? _________________________________________________________

_____ Student single membership is $10.00 a year.  _____ Regular single membership is $15.00 a year.
_____ Double membership (two people, one address) is $20.00 a year.

I wish to pay my membership dues for ____________________ year(s).

Contributions to the International Lawrence Durrell Society are tax deductable

under U.S. law [509 (a) (1)]. I wish to make a tax-deductable contribution of________________ .

Subscriptions to Deus Loci: The Lawrence Durrell Journal:

($10/year additional; add $2/year surface mail or $8.00 for air for subscriptions to be sent outside of North America)

Enroll me for a continuing subscription to Deus Loci beginning with issue number ____________.

Individual orders:

Send me ________ copies of Deus Loci numbers _________________________________.

Issues available: #1 (1992), #2 (1993), #3 (1994), #4 (1995-96), #5 (1997), #6 (1998), #7 (1999-2000), #8 (2001-2002), #9 (2003-2005)

Amount Enclosed:______________

Mail this form and your check or money order in U.S. dollars payable to the International Lawrence Durrell Society to:

Paul H. Lorenz, Secretary/Treasurer, International Lawrence Durrell Society,

3201 S. Beech Street #40, Pine Bluff, AR 71603 USA

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