DATE ______________________

MEMBERSHIP CATEGORIES
(CIRCLE ONE):

Life Member- $200 /person

Supporting- $50 /year

Family/Household - $25 /year

Couple - $20 /year

INDIVIDUAL - $15 /year

Junior/Student- $5 /year

 

NAME(S)____________________________________________________________

ADDRESS___________________________________________________________

CITY____________________________, STATE______ ZIP___________________

PHONE________________________ E-MAIL______________________________

PLEASE SEND THIS APPLICATION WITH YOUR DUES TO: