Please Print and Mail to:

Mrs. Dorothy R. Jones, Treasurer
130 Florence
Highland Park, MI 48203

Detroit Association of Black Storytellers
Application for Membership

Name:____________________________________________________________________________
             Title                  First                                        Initial                 Last

Address:__________________________________________________________________________

Communication:________________________________    __________________________________
                                    Home Telephone                                            Work Telephone

                        ________________________________    __________________________________
                                    E-mail                                                             Fax Telephone

Student:_____________________________________     __________________________________
                                     School                                                           Grade

Check Your Membership Category

____    Corporate                    $500

____     Life Membership         $350

____     Organization                $100

____     Family                         $35 (Adults)

____     Individual                     $20

____     Senior (65 over)           $15

____     Student                         $10

Please make checks payable to:  Detroit Association of Black Storytellers, inc. or DABS