24 Frank Lloyd Wright Drive  PO Box 442, Suite H-2100  Ann Arbor, MI 48106
Office: (734) 232-2154 / Fax: (734) 647-6263
http://www.med.umich.edu/sheldonsociety/
STATEMENT OF ANNUAL DUES – 2016
Membership Status – Active
Dues - $200.00
* Forgot to pay 2015? Pay now - $200.00
Endowment Pledge
_____ $100
_____$250
_____$500
_____$1000
_____Other (Write In)
TOTAL _____
** Mark on your check (Memo Section) what you’re paying. **
Please Note: If paying by check, please be sure to mail your check by December 31, 2015
to ensure proper tax credit.
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