Membership Application
(Please print clear)
Date: ___________________________________
Last name: ___________________________ First name: _________________________________
Address: _______________________________________________________________________________________
City: ______________________________ State: ________________ Zip Code: _____________________
Phone Number: (______) ________________________ TTY ____ Voice ____ Fax ____
Email Address: _______________________________________________________________________________________
Annual Membership Dues
| ___ Individual $10.00 | ___ Senior Individual $8.00* |
| ___ Family/Couple $15.00 | ___ Senior Couple $12.00* |
| ___ Student $8.00** | ___ Donation $___________ |
* 60 years old or older
**18 year old+ and ID required
Lifetime membership
| ____ Individual $100.00 | ___ Family/Couple $150.00 |
Membership Total:$______________