Membership Application/Renewal Form

Membership type:
Individual ($22)___    Family [for existing Family members only] ($26)___    Individual Life ($264)___    Supporting ($500)___    Benefactor ( $1,000)___

Name _____________________________                                                            
Address ___________________________                                                          
City ___________________________ State ____ 
ZIP + 4   __ __ __ __ __ - __ __ __ __                             

Phone  (___) ____-_________  E - mail __________________________

Do you want a Membership Card?  ____ Yes   ____ No

Your canceled check is  your receipt
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(For Society's Use)   ID # _____ LOG # ______ Cash ____  Check # ____  Amount _____ Date _________
 New Expiration Date  ________