| Membership
year_______________ (Membership year is Jan 1
to Dec 31) |
| Type of membership
(please check one) |
Organizational
$250 |
|
Affiliate $100 |
|
Individual $50 |
Name of Organization * Affiliate * Individual
___________________________________________________________
Contact person (Organizational and Affiliate
Members)
____________________________________
Contact person's signature (Verifies that membership
guidelines are met - see below)
____________________________________
|