(Membership year: October1st through September 30th)

New Member [    ]    Renewal [    ]

[    ]  Individual        $20.00

[    ] Couple       $30.00

[   ]  Student or Senior (60+)              $15.00

[   ] Family w/ children under 18           $35.00

[   ] Business/ Organization         $50.00

[   ] Life (one time fee) per person         $250.00

Name______________________________________________________

Address_____________________________________________________

City ______________________ State _________ Zip _________________

Phone __________________  E-mail ______________________________

Date ________________  Signed _________________________________

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