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Membership Form

Order of Kush Membership Form

· To become a member of the Order of Kush online, please fill out the form below and click "submit." Please remember to send in your payment.

· Or print the form and mail it with your payment to the address at the bottom of the form.

All benefits of membership will become active once payment is received.

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* Salutation:

* First Name:

Middle Initial:

* Last Name:

Suffix:

* Title:

* E-mail:

* Company:

* Address 1:

Address 2:

* City:

* State/Province:

* Zip/Postal Code:

* Country:

* Phone Number:

Fax Number:

Stay informed! Get updates about programs, scholarships, job opportunities, featured products and services, and educational opportunities.

* May we send you information using e-mail (or fax)?
Yes, please use e-mail (or fax) to send me information.
Please do not use the contact details provided here to send me information.

By submitting this form, you agree that Order of Kush International may process your data in a manner indicated above and as described in our privacy policy.

Subscribe now to the African Historian Journal
Published quarterly in English for Order of Kush members for only $12. This journal provides important information on trends and ideas in the fields of History, Archaeology and other related disciplines.

* Please indicate your desired giving level and membership status:
Honors Student $35 (Student must provide official transcript from school)
Affiliate $3000
Historian $35
Associate $40
Life $1000
Archaeologist $35
Student/Retiree $25 (Student must provide Student I.D.)
Other (please specify):

* What other role would you like to play in helping Order of Kush scholars reach their potential?
I would like to be a part of OK with a membership gift of $

I would like to pledge $ to be paid monthly quarterly.

(Optional) This is an Honorary Memorial gift for:

I have provided for Order of Kush in my will.
I would like more information about providing for Order of Kush in my will.
I would like information about how to make a gift to Order of Kush that increases my income and makes possible a current tax deduction.
(Optional) Please Notify:

Address:

I found out about Order of Kush from:

* Would you like an Order of Kush International representative to contact you regarding this information?

Yes

If this form will not email, please print it out and mail it to the address below. Thank you.

Make out checks in U.S. currency payable to Order of Kush.

Sorry, we do not accept credit/debit cards at this time.

Please send payments and correspondence to the address below:

Order of Kush International
559 W. Diversey Parkway, #315
Chicago, IL 60614
Email: info@orderofkush.org

Order of Kush

Membership Form