MEMBERSHIP FORM

MEMBERSHIP REGISTRATION FORM

Name

Birthday

Street Address

Street Address Line 2

City

Region/State/Province

Postal / Zip code

Phone:

What are your hobbies or special interests:

What are some things that you value in an orgaizaion?

Complete only if you are purchasing a family membership:

Spouse/Significant Other name:

DOB:

Occupation:

List Children who are in household who will be members:

Name:

DOB:

Select a Membership ($)

Annual Individual Membership - $25.00

Annual Family Membership - $40.00

Thank you for your membership

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