Mr./Mrs./Ms./Dr.
___________________________
Name of Spouse ___________________________
Address: ________________________________
________________________________
City: ________________ State: _______ Zip:
_______
Home Phone: _________ Work Phone:
_________
Email Address:_____________________________
| Select category of Membership
Desired (circle one): |
|
| Individual
$35.00 |
Family $35.00 |
| Sponsor $50.00 |
Patron $100.00 |
| Sustainer $500.00 |
Benefactor/Lifetime $1,000.00 |
Volunteer Opportunities
___ If you would like to become a volunteer or
serve on any of our committees, please check
here, one of our board members will call you
- Thank you.
Best time to be called?
___________a.m/p.m.
Please print the form and send it
to the address below.
