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✓ To the Board of Directors of The Fifth Avenue Association, Inc. 358 Fifth Avenue New York City [[blank line]] 192[[blank line]] SUSTAINING MEMBERSHIPS Class AA --- $1000 Class A ---- 750 Class B ---- 500 Class C ---- $250 Class D ---- 100 Class E ---- 50 Standard Dues, Twenty-five Dollars a Year No initiation fee or additional assessments The undersigned hereby makes application for Membership in The Fifth Avenue Association, Inc., and, if elected to membership therein, agrees to pay on demand [[blank line]] Dollars ($ ) per annum in advance. A check accompanies this application. Name [[blank line]] Address [[blank line]] Name of Executive [[blank line]] Business Classification [[blank line]]