| Name |
______________________________ |
| Family Names |
______________________________ |
| Address |
______________________________ |
| City |
______________________________ |
| State / Zip |
______________________________ |
| Phone |
______________________________ |
| Email |
______________________________ |
|
|
| Membership Categories & Fees |
| ___ Limited (non voting) |
$15 / yr |
| ___ Veteran (voting) |
$15 / yr |
| ___ Regular (individual) |
$30 / yr |
| ___ Regular (family) |
$50 / yr |
| ___ Supporting (family) |
$75 / yr |
| ___ Patron (family) |
$100 / yr |
| ___ Sustaining (family lifetime) |
$1000 |
| ___ Business |
$200 / yr |
| ___ Donation |
$______ |
| Total |
$______ |
|